AlAzmi Aeshah, Jastaniah Wasil, AlDabbagh Mona, Elimam Naglla
Department of Pharmaceutical Care Clinical Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
J Oncol Pharm Pract. 2021 Apr;27(3):560-569. doi: 10.1177/1078155220925161. Epub 2020 May 31.
There are a limited number of studies that address non-neutropenic fever episodes in children with cancer, and no standard approach exists.
We opt to retrospectively analyze the efficacy of the current clinical approach for management of non-neutropenic fever episodes and the associated risk factors among children with cancer at the Princess Noorah Oncology Center from May 2016 through December 2017.
A total of 480 non-neutropenic fever episodes were identified in 131 children, of which 62 episodes were triaged as high-risk non-neutropenic fever and 418 as low-risk non-neutropenic fever. Of those 480 non-neutropenic fever, 361 episodes (75.2%) were associated with the presence of central venous catheters. The overall failure rate of ceftriaxone mono-therapy was observed in 75.6% (11.7% in high-risk non-neutropenic fever with a mean C-reactive protein level of 21.1 (±23.2) mmol/L and 63.9% in low-risk non-neutropenic fever with a mean C-reactive protein level of 17.6 (±53.9) mmol/L). The overall bacteremia rate was 14.4%. The type of organisms isolated was mainly high-risk organisms in 59 non-neutropenic fever episodes (85.5%), OR 1.78 (95% CI: 0.45-7.04) p = 0.41. Of note, all bacteremia were associated with the presence of central venous catheter (100%). Of all the examined risk factors of outpatient treatment failure in low-risk non-neutropenic fever, only prolonged fever of more than three days were significantly associated with bacteremia OR 8.107 [95% CI: 1.744-37.691], p = 0.008. Noteworthy is that almost 43% of non-neutropenic fever episodes were associated with respiratory symptoms. This study provides a baseline for future prospective research assessing the pattern of non-neutropenic fever by focusing on associated risk factors.
针对癌症患儿非中性粒细胞减少性发热发作的研究数量有限，且尚无标准方法。
我们选择回顾性分析2016年5月至2017年12月期间在努拉公主肿瘤中心对癌症患儿非中性粒细胞减少性发热发作的当前临床治疗方法的疗效及相关危险因素。
在131名儿童中总共确定了480次非中性粒细胞减少性发热发作，其中62次发作被分类为高危非中性粒细胞减少性发热，418次为低危非中性粒细胞减少性发热。在这480次非中性粒细胞减少性发热中，361次发作（75.2%）与中心静脉导管的存在有关。头孢曲松单药治疗的总体失败率为75.6%（高危非中性粒细胞减少性发热中为11.7%，平均C反应蛋白水平为21.1（±23.2）mmol/L；低危非中性粒细胞减少性发热中为63.9%，平均C反应蛋白水平为17.6（±53.9）mmol/L）。总体菌血症发生率为14.4%。在59次非中性粒细胞减少性发热发作（85.5%）中分离出的生物体类型主要为高危生物体，比值比为1.78（95%置信区间：0.45 - 7.04），p = 0.41。值得注意的是，所有菌血症均与中心静脉导管的存在有关（100%）。在低危非中性粒细胞减少性发热门诊治疗失败的所有检查危险因素中，只有持续发热超过三天与菌血症显著相关，比值比为8.107 [95%置信区间：1.744 - 37.691]，p = 0.008。值得注意的是，几乎43%的非中性粒细胞减少性发热发作与呼吸道症状有关。本研究通过关注相关危险因素为未来评估非中性粒细胞减少性发热模式的前瞻性研究提供了基线。
