Division of Hospital Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Pediatr Blood Cancer. 2019 Mar;66(3):e27550. doi: 10.1002/pbc.27550. Epub 2018 Nov 26.
There are no consensus guidelines for management of pediatric oncology patients presenting with fever and nonneutropenia, with limited research into the outcomes of withholding empiric i.v. antibiotics. We conducted a prospective cohort study assessing the safety and efficacy of observing well-appearing patients presenting with fever and nonneutropenia (absolute neutrophil count ≥ 500 cells/mm ). Of 238 episodes, 82.7% patients were observed with no infectious complications and low overall incidence of bacteremia (3.4%). There were no significant differences in individual clinical variables. We propose that observation alone in some well-appearing febrile pediatric oncology patients is safe and limits the use of unnecessary empiric antibiotics.
目前尚无针对儿科肿瘤患者发热伴非中性粒细胞减少症管理的共识指南，并且对于避免经验性静脉使用抗生素的结果的研究也很有限。我们进行了一项前瞻性队列研究，评估了观察表现良好的发热伴非中性粒细胞减少症（绝对中性粒细胞计数≥500 个/ mm ）患者的安全性和疗效。在 238 例发作中，82.7%的患者未发生感染并发症，菌血症总发生率较低（3.4%）。各个临床变量之间无显著差异。我们提出，对于某些表现良好的发热儿科肿瘤患者，单独观察是安全的，并限制了不必要的经验性抗生素的使用。
