CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.
Service de Pédiatrie, CHU Poitiers, Poitiers, France.
J Infect. 2024 Jun;88(6):106171. doi: 10.1016/j.jinf.2024.106171. Epub 2024 Apr 30.
ECIL-2021 recommends discontinuing empirical antibiotic therapy (EAT) in febrile-neutropenic children after 72 h of treatment and at least 24-48 h of apyrexia in the case of fever of unknown origin (FUO). These guidelines are rarely applied to high-risk children's neutropenia.
We retrospectively included all consecutive FUO episodes occurring during profound neutropenia ≥ 10 days in children in our institution. We evaluated the safety of EAT discontinuation in patients for whom the ECIL guidelines were followed compared to those for whom they didn't. We used a combined criterion of mortality and intensive care unit admission at 30 days. We identified risk factors for recurrent fever after EAT discontinuation.
Fifty-one FUO episodes occurred in 37 patients. EAT discontinuation followed ECIL guidelines in 19 (37 %) episodes. No deaths and-or transfers in ICU occurred in the ECIL group. The duration of EAT was shorter by nine days in the group following ECIL guidelines (p < 0.001). We observed 14 (27 %) episodes of recurrent fever. Mucositis was significantly associated with recurrent fever (p < 0.01).
EAT discontinuation seems feasible and safe in FUO during prolonged febrile neutropenia in children. However, mucosal lesions should prompt thorough surveillance due to the risk of recurrent fever.
ECIL-2021 建议在发热性中性粒细胞减少症儿童接受治疗 72 小时后，且在不明原因发热（FUO）的情况下至少发热消退 24-48 小时后停止经验性抗生素治疗（EAT）。这些指南很少适用于高危儿童的中性粒细胞减少症。
我们回顾性地纳入了我院所有连续发生的、中性粒细胞减少症≥10 天且 FUO 持续时间超过 72 小时的患儿。我们评估了在遵循 ECIL 指南和未遵循 ECIL 指南的情况下，EAT 停止的安全性。我们使用死亡率和 30 天内入住 ICU 的综合标准来评估。我们确定了 EAT 停药后复发性发热的危险因素。
37 名患儿中共有 51 次 FUO 发作。19 次（37%）FUO 发作遵循 ECIL 指南停止 EAT。在遵循 ECIL 指南的患儿中，无死亡和/或转 ICU 病例。遵循 ECIL 指南组的 EAT 时间缩短了 9 天（p<0.001）。我们观察到 14 次（27%）复发性发热。口腔黏膜炎与复发性发热显著相关（p<0.01）。
在儿童持续发热性中性粒细胞减少症期间，FUO 中停止 EAT 似乎是可行且安全的。然而，由于存在复发性发热的风险，黏膜损伤应引起彻底监测。
