Givone Aude, Duval-Destin Jean, Delebarre Mathilde, Abou-Chahla Wadih, Lervat Cyril, Dubos François
Pediatric Emergency Unit & Infectious Diseases, Centre Hospitalier Universitaire de Lille, Lille, France.
Pediatric Emergency Unit, Saint-Vincent-de-Paul Hospital, GHICL, Lille, France.
Pediatr Hematol Oncol. 2024;41(2):172-178. doi: 10.1080/08880018.2023.2218406. Epub 2023 Jun 9.
Our aim was to identify national consensus criteria for the management of children with chemotherapy-induced febrile neutropenia (FN), for evidence-based step-down treatment approaches for patients classified at low risk of severe infection. In 2018, a five-section, 38-item survey was e-mailed to all pediatric hematology and oncology units in France ( = 30). The five sections contained statements on possible consensus criteria for the (i) definition of FN, (ii) initial management of children with FN, (iii) conditions required for initiating step-down therapy in low-risk patients, (iv) management strategy for low-risk patients, and (v) antibiotic treatment on discharge. Consensus was defined by respondents' combined answers (somewhat agree and strongly agree) at 75% or more. Sixty-five physicians (participation rate: 58%), all specialists in pediatric onco-hematology, from 18 centers completed the questionnaire. A consensus was reached on 22 of the 38 statements, including the definition of FN, the criteria for step-down therapy in low-risk children, and the initial care of these patients. There was no consensus on the type and duration of antibiotic therapy on discharge. In conclusion, a consensus has been reached on the criteria for initiating evidence-based step-down treatment of children with FN and a low risk of severe infection but not for the step-down antimicrobial regimen.
我们的目标是确定化疗引起的发热性中性粒细胞减少症(FN)患儿管理的全国共识标准,以及针对严重感染低风险患者的循证降阶梯治疗方法。2018年,一份包含五个部分、38个条目的调查问卷通过电子邮件发送给了法国所有的儿科血液学和肿瘤学单位(共30个)。这五个部分包含了关于以下方面可能的共识标准的陈述:(i)FN的定义;(ii)FN患儿的初始管理;(iii)低风险患者开始降阶梯治疗所需的条件;(iv)低风险患者的管理策略;(v)出院时的抗生素治疗。共识由受访者75%及以上的综合回答(有点同意和强烈同意)来定义。来自18个中心的65名医生(参与率:58%),均为儿科肿瘤血液学专家,完成了问卷。38条陈述中有22条达成了共识,包括FN的定义、低风险儿童降阶梯治疗的标准以及这些患者的初始护理。出院时抗生素治疗的类型和持续时间未达成共识。总之,对于启动FN且严重感染风险低的儿童进行循证降阶梯治疗的标准已达成共识,但对于降阶梯抗菌方案尚未达成共识。