UC Davis Medical Center, Sacramento, CA.
J Pediatr Hematol Oncol. 2021 Aug 1;43(6):e880-e885. doi: 10.1097/MPH.0000000000002074.
Recent studies suggest outpatient therapy, oral antibiotics, or earlier discharge could be appropriate in some pediatric patients admitted with febrile neutropenia; supporting data are lacking. Retrospective chart review of patients admitted from September 2005 through October 2016 identified 131 "early discharge" febrile neutropenia admissions with discharge absolute neutrophil count (ANC) <500/µl and negative cultures. All were afebrile and discharged without outpatient antibiotics. Eleven of 131 patients (8%) were readmitted. Two patients called back for late positive cultures. Nine were readmitted with febrile neutropenia; 2 had positive cultures on readmission. All 4 patients with positive cultures were safely treated with appropriate antibiotics. The remaining 7 patients had uneventful readmissions. Average ANC (SD) at discharge was lower for patients readmitted versus those not readmitted (69 [70] vs. 196 [145], P≤0.001), as was absolute phagocyte count (APC) at discharge (97 [82] vs. 453 [431], P≤0.001). APC on admission was not significantly lower for those readmitted (165 [254] vs. 321 [388], P=0.09). Few patients required readmission; those with bacterial infections were easily identified and appropriately treated. Higher ANC or APC criteria for discharge would increase length of hospital stay without decreasing morbidity. A subset of patients admitted with febrile neutropenia can be safely discharged before count recovery without oral antibiotics.
最近的研究表明，对于因发热性中性粒细胞减少症而住院的某些儿科患者，门诊治疗、口服抗生素或提前出院可能是合适的；但缺乏支持数据。对 2005 年 9 月至 2016 年 10 月期间住院的发热性中性粒细胞减少症患者的病历进行回顾性分析，确定了 131 例出院时绝对中性粒细胞计数（ANC）<500/µl 且培养结果为阴性的“提前出院”发热性中性粒细胞减少症患者。所有患者均无发热，出院时未使用门诊抗生素。131 例患者中有 11 例（8%）再次入院。其中 2 例因迟发阳性培养结果而召回。9 例因发热性中性粒细胞减少症再次入院；其中 2 例在再次入院时培养阳性。所有 4 例培养阳性的患者均安全地接受了适当的抗生素治疗。其余 7 例患者再次入院时情况稳定。与未再次入院的患者相比，再次入院的患者出院时 ANC（标准差）较低（69[70] vs. 196[145]，P≤0.001），出院时绝对吞噬细胞计数（APC）也较低（97[82] vs. 453[431]，P≤0.001）。再次入院的患者入院时的 APC 也没有明显降低（165[254] vs. 321[388]，P=0.09）。很少有患者需要再次入院；那些有细菌感染的患者很容易被识别并得到适当治疗。提高出院时 ANC 或 APC 标准会延长住院时间，而不会降低发病率。发热性中性粒细胞减少症患者中，有一部分在计数恢复前可安全出院，无需口服抗生素。
