Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; EA2694, Public Health, Epidemiology and Quality of Care, F-59000 Lille, France; CHU Lille, Pediatric Emergency Unit & Infectious Diseases, F-59000 Lille, France.
Univ. Lille, CHU Lille, 2 avenue Oscar Lambret, F-59000 Lille, France; CHU Lille, Microbiology Unit, Pathology-Biology Center, F-59000 Lille, France.
J Infect. 2019 Aug;79(2):95-100. doi: 10.1016/j.jinf.2019.06.008. Epub 2019 Jun 19.
To describe and analyze the differences between infections in children with febrile neutropenia (FN) treated for solid tumor or blood cancer.
A prospective study included all episodes of FN in children from April 2007 to April 2016 in 2-pediatric cancer centers in France. Medical history, clinical and laboratory data available at admission and final microbiological data were collected. The proportion of FN, severe infection, categories of microorganisms and outcomes were compared between the two groups. The presumed gateway of the infection was a posteriori considered and evaluated.
We analyzed 1197 FN episodes (mean age: 8 years). 66% of the FN episodes occurred in children with blood cancer. Severe infections were identified in 23.4% of episodes overall. The rate of severe infection (28.4% vs. 10.4%), types of microorganisms and the need for a management in intensive care unit (2.6% vs. 0.5%) was significantly different between children with blood cancer and solid tumor. Digestive or respiratory presumed gateway of the infections was less frequent for patients with solid tumor.
Given these important microbiological and clinical differences, it may be appropriate to consider differently the risk of severe infection in these two populations and therefore the management of FN.
描述和分析接受实体瘤或血液系统恶性肿瘤治疗的中性粒细胞减少伴发热患儿的感染差异。
前瞻性研究纳入了 2007 年 4 月至 2016 年 4 月法国 2 家儿科肿瘤中心收治的所有中性粒细胞减少伴发热患儿的感染事件。收集患儿的病史、入院时的临床和实验室数据以及最终的微生物学数据。比较两组患儿的中性粒细胞减少伴发热比例、严重感染、微生物种类和结局。随后回顾性分析感染的潜在来源。
共分析了 1197 例中性粒细胞减少伴发热事件（中位年龄 8 岁）。66%的中性粒细胞减少伴发热事件发生于血液系统恶性肿瘤患儿。整体严重感染率为 23.4%。血液系统恶性肿瘤患儿的严重感染率（28.4%比 10.4%）、微生物种类和需要入住重症监护病房的比例（2.6%比 0.5%）显著高于实体瘤患儿。对于实体瘤患儿，感染的潜在消化道或呼吸道来源较少。
鉴于这些重要的微生物学和临床差异，可能需要对这两种人群的严重感染风险进行不同的评估，从而对中性粒细胞减少伴发热进行不同的管理。
