Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
Centre for Reviews and Dissemination, University of York, York, UK.
BMJ Paediatr Open. 2022 Mar;6(1). doi: 10.1136/bmjpo-2021-001339.
Febrile neutropenia (FN) is a common complication of cancer treatment in children and young people, and many episodes are over-treated. Procalcitonin, may be an appropriate tool to guide the stopping of antibiotics in those at low risk of serious bacterial infection. Supportive care trials in this population have proven to be difficult to undertake. This single-arm pilot study aimed to evaluate whether a study using a procalcitonin-guided stopping-rule for antibiotics in paediatric FN is possible.
Daily procalcitonin levels were performed during episodes of FN and clear guidance given for antibiotic discontinuation. Episode data and quantitative feasibility data were collected alongside interviews with professionals and ethnographic observations. Analysis was descriptive.
Of 32 patients and families approached, 28 patients consented, and 13 had febrile neutropenia. In total, 16 episodes were included in the study. All relevant FN episodes had data captured, with adequate data collection. There were no significant safety events. In 4/8 (50%) of episodes without clear microbiologically documented or clinical infection, antibiotics were reduced in duration or in spectrum. Interviews with professionals revealed the importance of the research, the value of key individuals in the study team, particular challenges of this protocol and suggestions for study improvements.
Studies to evaluate procalcitonin-guided approaches to stopping antibiotics in paediatric FN are possible.
发热性中性粒细胞减少症（FN）是儿童和青少年癌症治疗的常见并发症，许多病例都过度治疗了。降钙素原可能是指导低风险严重细菌感染患者停止使用抗生素的合适工具。在该人群中进行的支持性护理试验已被证明难以进行。这项单臂试验旨在评估在儿科 FN 中使用降钙素原指导抗生素停药规则的研究是否可行。
在 FN 发作期间每天进行降钙素原检测，并为抗生素停药提供明确指导。收集病例数据和定量可行性数据，并对专业人员进行访谈和民族志观察。分析是描述性的。
在接触的 32 名患者和家属中，有 28 名患者同意，其中 13 名患有发热性中性粒细胞减少症。共有 16 个病例纳入研究。所有相关的 FN 病例均有数据记录，且数据收集充足。没有发生重大安全事件。在 8 例（50%）无明确微生物学记录或临床感染的病例中，抗生素的使用时间或种类减少。对专业人员的访谈揭示了研究的重要性、研究团队中关键人员的价值、该方案的特殊挑战以及对研究改进的建议。
评估降钙素原指导儿科 FN 中停止使用抗生素的方法的研究是可行的。
