Cennamo Federica, Masetti Riccardo, Largo Prisca, Argentiero Alberto, Pession Andrea, Esposito Susanna
Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
Pediatric Oncology and Hematology Unit "Lalla Seragnoli", Pediatric Unit-IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Children (Basel). 2021 Nov 25;8(12):1086. doi: 10.3390/children8121086.
Febrile neutropenia (FN) is a common complication of chemotherapy in oncological children and one of the most important causes of morbidity and mortality in these patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome. We analyzed the literature in order to clarify the epidemiology of FN in children undergoing chemotherapy, the specific factors associated with a negative outcome, the most common etiology, and the value of biological markers as a tool to make an early diagnosis or to monitor the evolution of the infection. Several studies have tried to identify specific factors that could help the clinician in the detection of an infection and in its microbiological identification. However, due to the heterogenicity of the available studies, sufficient evidence is lacking to establish the role of these risk factors in clinical practice and future research on this topic appear mandatory. Determinations of risk factors, etiology, and markers of febrile episodes in these patients are complicated by the characteristics of the underlying illness and the effects of treatments received. Although some studies have tried to develop an evidence-based guideline for the empiric management of FN in pediatrics, validated predictive scores and algorithms are still lacking and urgently needed.
发热性中性粒细胞减少症（FN）是肿瘤患儿化疗常见的并发症，也是这些患者发病和死亡的最重要原因之一。早期检测菌血症并迅速进行治疗干预对于改善预后至关重要。我们分析了相关文献，以阐明接受化疗儿童FN的流行病学、与不良结局相关的具体因素、最常见的病因以及生物标志物作为早期诊断或监测感染进展工具的价值。多项研究试图确定有助于临床医生检测感染及其微生物鉴定的具体因素。然而，由于现有研究的异质性，缺乏足够证据来确立这些危险因素在临床实践中的作用，因此关于该主题的未来研究显得十分必要。这些患者发热发作的危险因素、病因及标志物的确定因基础疾病的特征和所接受治疗的影响而变得复杂。尽管一些研究试图制定基于证据的儿科FN经验性管理指南，但仍缺乏经过验证的预测评分和算法，且迫切需要这些。
