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儿童血液学和肿瘤学患者中性粒细胞减少性发热管理共识文件,由西班牙儿科学感染病学会(SEIP)和西班牙儿科学血液学和肿瘤学会(SEHOP)共同制定。

Consensus document on the management of febrile neutropenia in paediatric haematology and oncology patients of the Spanish Society of Pediatric Infectious Diseases (SEIP) and the Spanish Society of Pediatric Hematology and Oncology (SEHOP).

机构信息

Unidad de Infectología Pediátrica, Hospital Universitario Torrecárdenas, Almería, Spain.

Servicio de Oncología y Hematología Pediátricas, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

出版信息

An Pediatr (Engl Ed). 2023 Jun;98(6):446-459. doi: 10.1016/j.anpede.2023.03.010. Epub 2023 May 31.

Abstract

Febrile neutropenia is one of the main infectious complications experienced by paediatric patients with blood or solid tumours, which, despite the advances in diagnosis and treatment, are still associated with a significant morbidity and mortality. These patients have several risk factors for infection, chief of which are chemotherapy-induced neutropenia, the disruption of cutaneous and mucosal barriers and the use of intravascular devices. Early diagnosis and treatment of febrile neutropenia episodes based on the patient's characteristics is essential in patients with blood and solid tumours to improve their outcomes. Therefore, it is important to develop protocols in order to optimise and standardise its management. In addition, the rational use of antibiotics, with careful adjustment of the duration of treatment and antimicrobial spectrum, is crucial to address the increase in antimicrobial drug resistance. The aim of this document, developed jointly by the Spanish Society of Pediatric Infectious Diseases and the Spanish Society of Pediatric Hematology and Oncology, is to provide consensus recommendations for the management of febrile neutropenia in paediatric oncology and haematology patients, including the initial evaluation, the stepwise approach to its treatment, supportive care and invasive fungal infection, which each facility then needs to adapt to the characteristics of its patients and local epidemiological trends.

摘要

发热性中性粒细胞减少症是血液或实体瘤儿科患者经历的主要感染并发症之一,尽管在诊断和治疗方面取得了进展,但仍与较高的发病率和死亡率相关。这些患者存在多种感染危险因素,其中主要有化疗引起的中性粒细胞减少、皮肤和黏膜屏障的破坏以及血管内装置的使用。基于患者的特征,早期诊断和治疗发热性中性粒细胞减少症对于血液和实体瘤患者改善其结局至关重要。因此,制定方案以优化和标准化其管理非常重要。此外,合理使用抗生素,仔细调整治疗持续时间和抗菌谱,对于解决抗菌药物耐药性的增加至关重要。本文件由西班牙儿科学会传染病分会和西班牙儿科学会血液学和肿瘤学分会联合制定,旨在为儿科肿瘤和血液学患者发热性中性粒细胞减少症的管理提供共识建议,包括初始评估、逐步治疗方法、支持性护理和侵袭性真菌感染,每个机构都需要根据患者的特点和当地的流行病学趋势进行调整。

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