儿童和青少年癌症患者及儿科造血干细胞移植受者感染管理指南
Guideline for the Management of Infection in Children and Adolescents With Cancer and Pediatric Hematopoietic Stem-Cell Transplantation Recipients.
作者信息
Diorio Caroline, Robinson Paula D, Ammann Roland A, Castagnola Elio, Erickson Kelley, Esbenshade Adam, Fisher Brian T, Haeusler Gabrielle M, Kuczynski Susan, Lehrnbecher Thomas, Phillips Robert, Cabral Sandra, Dupuis L Lee, Sung Lillian
机构信息
Caroline Diorio, Paula D. Robinson, and Sandra Cabral, Pediatric Oncology Group of Ontario; Caroline Diorio, L. Lee Dupuis, and Lillian Sung, The Hospital for Sick Children; L. Lee Dupuis, University of Toronto, Toronto; Caroline Diorio, McMaster Children's Hospital, Hamilton; Susan Kuczynski, Ontario Parents Advocating for Children with Cancer, Barrie, Ontario, Canada; Roland A. Ammann, Bern University Hospital, University of Bern, Bern, Switzerland; Elio Castagnola, Istituto Giannina Gaslini, Genova, Italy; Kelley Erickson and Brian T. Fisher, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; Adam Esbenshade, Vanderbilt-Ingram Cancer Centre, Nashville, TN; Gabrielle M. Haeusler, Peter MacCallum Cancer Centre, Melbourne; Gabrielle M. Haeusler, Royal Children's Hospital, Parkville; Gabrielle M. Haeusler, Paediatric Integrated Cancer Service, Victoria, Australia; Thomas Lehrnbecher, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany; Robert Phillips, Leeds Teaching Hospital, National Health Service Trust, Leeds; and Robert Phillips, University of York, York, United Kingdom.
出版信息
J Clin Oncol. 2018 Nov 1;36(31):3162-3171. doi: 10.1200/JCO.18.00407. Epub 2018 Sep 14.
PURPOSE
The aim of this work was to develop a clinical practice guideline for the prevention and treatment of infection (CDI) in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT) patients.
METHODS
An international multidisciplinary panel of experts in pediatric oncology and infectious diseases with patient advocate representation was convened. We performed systematic reviews of randomized controlled trials for the prevention or treatment of CDI in any population and considered the directness of the evidence to children with cancer and pediatric HSCT patients. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to generate recommendations.
RESULTS
The panel made strong recommendations to administer either oral metronidazole or oral vancomycin for the initial treatment of nonsevere CDI and oral vancomycin for the initial treatment of severe CDI. Fidaxomicin may be considered in the setting of recurrent CDI. The panel suggested that probiotics not be routinely used for the prevention of CDI, and that monoclonal antibodies and probiotics not be routinely used for the treatment of CDI. A strong recommendation to not use fecal microbiota transplantation was made in this population. We identified key knowledge gaps and suggested directions for future research.
CONCLUSION
We present a guideline for the prevention and treatment of CDI in children and adolescents with cancer and pediatric HSCT patients. Future research should include randomized controlled trials that involve children with cancer and pediatric HSCT patients to improve the management of CDI in this population.
目的
本研究旨在制定一项针对癌症儿童和青少年以及儿科造血干细胞移植（HSCT）患者感染（CDI）的预防和治疗的临床实践指南。
方法
召集了一个由儿科肿瘤学和传染病领域的国际多学科专家小组，并邀请了患者权益倡导者代表。我们对任何人群中预防或治疗CDI的随机对照试验进行了系统评价，并考虑了证据对癌症儿童和儿科HSCT患者的直接适用性。我们采用推荐分级评估、制定和评价方法来生成推荐意见。
结果
专家组强烈推荐使用口服甲硝唑或口服万古霉素进行非重症CDI的初始治疗，使用口服万古霉素进行重症CDI的初始治疗。复发性CDI的情况下可考虑使用非达霉素。专家组建议益生菌不应常规用于预防CDI，单克隆抗体和益生菌不应常规用于治疗CDI。强烈建议在该人群中不使用粪便微生物群移植。我们确定了关键的知识空白，并提出了未来研究的方向。
结论
我们提出了一项针对癌症儿童和青少年以及儿科HSCT患者CDI预防和治疗的指南。未来的研究应包括涉及癌症儿童和儿科HSCT患者的随机对照试验，以改善该人群中CDI的管理。
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