Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA.
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Cancer. 2022 Dec 1;128(23):4129-4138. doi: 10.1002/cncr.34476. Epub 2022 Oct 13.
Infections cause significant treatment-related morbidity during pediatric acute lymphoblastic leukemia/lymphoma (ALL/LLy) therapy. Fevers during periods without severe neutropenia are common, but etiologies are not well-described. This study sought to describe the bloodstream infection (BSI) and non-BSI risk in children undergoing therapy for ALL/LLy.
Demographic and clinical data were abstracted for febrile episodes without severe neutropenia at two children's hospitals. Treatment courses were stratified by intensity. Multivariate logistic regression evaluated characteristics associated with infection.
There were 1591 febrile episodes experienced by 524 patients. Of these, 536 (34%) episodes had ≥1 infection; BSI occurred in 30 (1.9%) episodes. No BSIs occurred in episodes with a recent procedural sedation or cytarabine exposure. Presence of hypotension, chills/rigors, higher temperature, and infant phenotype were independently associated with BSI (p < .05). Of the 572 non-BSIs, the most common was upper respiratory infection (URI) (n = 381, 67%). Compared to episodes without infection, URI symptoms, higher temperature, absolute neutrophil count 500-999/μl, and evaluation during a low-intensity treatment course were more likely to be associated with a non-BSI (p < .05) and inpatient status was less likely to be associated with a non-BSI (p < .05).
The BSI rate in pediatric patients with ALL/LLy and fever without severe neutropenia is low, but one-third of the time, patients have a non-BSI. Future research should test if the need for empiric antibiotics can be tailored based on the associations identified in this study.
在小儿急性淋巴细胞白血病/淋巴瘤（ALL/LLy）治疗期间，感染会导致显著的治疗相关发病率。在没有严重中性粒细胞减少症的时期发热很常见，但病因描述不详。本研究旨在描述接受 ALL/LLy 治疗的儿童发生血流感染（BSI）和非 BSI 的风险。
从两家儿童医院的无严重中性粒细胞减少症的发热患者中提取了人口统计学和临床数据。根据治疗强度对治疗过程进行分层。多变量逻辑回归评估了与感染相关的特征。
524 名患者共发生了 1591 次发热事件。其中 536 次（34%）事件有≥1 次感染；30 次（1.9%）事件发生了 BSI。近期程序性镇静或阿糖胞苷暴露的发热事件中未发生 BSI。低血压、寒战/肌强直、更高的体温和婴儿表型与 BSI 独立相关（p<.05）。在 572 例非 BSI 中，最常见的是上呼吸道感染（URI）（n=381，67%）。与无感染的发热事件相比，URI 症状、更高的体温、中性粒细胞计数 500-999/μl、在低强度治疗过程中评估更可能与非 BSI 相关（p<.05），而住院状态与非 BSI 相关的可能性较小（p<.05）。
在患有 ALL/LLy 和无严重中性粒细胞减少症发热的小儿患者中，BSI 发生率较低，但三分之一的患者有非 BSI。未来的研究应检验是否可以根据本研究中确定的关联来调整经验性抗生素的使用需求。
