口服左氧氟沙星降阶梯治疗儿童恶性肿瘤伴发热性中性粒细胞减少症。

Oral Step-Down Therapy With Levofloxacin for Febrile Neutropenia in Children With Cancer.

机构信息

Department of Pharmacy, Primary Children's Hospital, Salt Lake City, Utah, USA.

Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.

出版信息

J Pediatric Infect Dis Soc. 2021 Feb 13;10(1):27-33. doi: 10.1093/jpids/piaa015.

DOI:10.1093/jpids/piaa015

PMID:32092134

Abstract

BACKGROUND

Although febrile neutropenia (FN) is a frequent complication in children with cancer receiving chemotherapy, there remains significant variability in selection of route (intravenous [IV] vs oral) and length of therapy. We implemented a guideline with a goal to change practice from using IV antibiotics after hospital discharge to the use of step-down oral therapy with levofloxacin for most children with FN until absolute neutrophil count > 500. The objectives of this study were to determine the impact of this guideline on home IV antibiotic use, and to evaluate the safety of implementation of this guideline.

METHODS

We performed a quasi-experimental, pre-post study of discharge FN treatment at a stand-alone children's hospital in patients without bacteremia discharged between January 2013 and October 2018. In January 2015, a multidisciplinary team created a guideline to switch most children with FN to oral levofloxacin, which was formally implemented as of September 2017. Discharges during the postintervention period (after September 2017) were compared to discharges in the preintervention period (between January 2013 and December 2014).

RESULTS

In adjusted multivariable regression analyses, the postimplementation period was associated with a decrease in home IV antibiotics (adjusted risk ratio [aRR], 0.07 [95% confidence interval {CI}, .03-.13]) and fewer IV antibiotic initiations within 24 hours of a new healthcare encounter up to 7 days after discharge (aRR, 0.39 [95% CI, .17-.93]) compared to the preintervention time period.

CONCLUSIONS

Step-down oral levofloxacin for children with FN who are afebrile with an ANC ≤ 500 at discharge is feasible and resulted in similar clinical outcomes compared to home IV antibiotics.

摘要

背景

尽管发热性中性粒细胞减少症（FN）是接受化疗的癌症儿童的常见并发症，但在选择途径（静脉[IV]与口服）和治疗时间长短方面仍存在显著差异。我们实施了一项指南，旨在改变从出院后使用静脉抗生素改为使用左氧氟沙星进行降阶梯口服治疗的做法，适用于大多数 FN 患儿，直至绝对中性粒细胞计数（ANC）>500。本研究的目的是确定该指南对家庭 IV 抗生素使用的影响，并评估实施该指南的安全性。

方法

我们对一家独立儿童医院的出院 FN 治疗进行了准实验、前后对照研究，研究对象为 2013 年 1 月至 2018 年 10 月期间无菌血症出院的患儿。2015 年 1 月，一个多学科团队制定了一项指南，将大多数 FN 患儿转为口服左氧氟沙星治疗，该指南自 2017 年 9 月起正式实施。将干预后（2017 年 9 月后）与干预前（2013 年 1 月至 2014 年 12 月）期间的出院情况进行比较。

结果

在调整后的多变量回归分析中，与干预前相比，实施后时期家庭 IV 抗生素的使用减少（调整后的风险比[aRR]，0.07 [95%置信区间 {CI}，0.03-0.13]），并且在出院后 7 天内，新医疗保健就诊后 24 小时内开始 IV 抗生素治疗的次数也减少（aRR，0.39 [95% CI，0.17-0.93]）。