Bash R O, Katz J A, Cash J V, Buchanan G R
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas 75235-9063.
Cancer. 1994 Jul 1;74(1):189-96. doi: 10.1002/1097-0142(19940701)74:1<189::aid-cncr2820740130>3.0.co;2-7.
Standard treatment for fever during periods of chemotherapy-induced neutropenia includes hospitalization and administration of intravenous antibiotics until the patient is afebrile and no longer neutropenic. This study prospectively evaluates the safety and cost-effectiveness of early discharge of selected low risk children before recovery from neutropenia.
We studied 74 children with cancer during 131 consecutive admissions for fever during a period of neutropenia. All patients initially were hospitalized and received broad-spectrum antibiotics. Intravenous antibiotic therapy was discontinued, and the patients promptly were discharged even if they had an absolute neutrophil count (ANC) of less than 500 cells/mm3 as long as they were afebrile, appeared clinically well, had negative cultures, exhibited control of local infection, and showed hematologic evidence of bone marrow recovery.
Intravenous antibiotics were discontinued in 82 cases (63%) before recovery of the ANC to more than 500 cells/mm3, and 78 patients were discharged immediately. None of 70 patients discharged while neutropenic but exhibiting a rising ANC at the time of discharge developed recurrent fever and required readmission. Thirty of these children had an improving localized infection when intravenous antibiotics were discontinued and completed a course of oral antibiotics at home. The estimated mean savings in hospital charges due to early discharge was $5058 per patient.
Low risk children with cancer who are hospitalized and treated for fever and neutropenia but appear clinically well may have intravenous antibiotics discontinued and be discharged safely irrespective of the ANC, as long as their granulocyte count is rising. This approach shortens hospital stays and results in considerable cost savings.
化疗引起的中性粒细胞减少期间发热的标准治疗包括住院并静脉注射抗生素，直至患者退热且不再中性粒细胞减少。本研究前瞻性评估了部分低风险儿童在中性粒细胞减少恢复前提前出院的安全性和成本效益。
我们研究了74例癌症患儿在中性粒细胞减少期间因发热连续131次入院的情况。所有患者最初均住院并接受广谱抗生素治疗。静脉抗生素治疗停止，即使患者的绝对中性粒细胞计数（ANC）低于500个细胞/mm³，只要他们退热、临床状况良好且稳定、培养结果为阴性、局部感染得到控制且有骨髓恢复的血液学证据，患者就会立即出院。
82例（63%）患者在ANC恢复至超过500个细胞/mm³之前停止了静脉抗生素治疗，78例患者立即出院。70例在中性粒细胞减少但出院时ANC上升的患者中，没有一例出现反复发热且需要再次入院。其中30例儿童在停止静脉抗生素治疗时局部感染有所改善，并在家中完成了口服抗生素疗程。提前出院估计每位患者平均节省住院费用5058美元。
因发热和中性粒细胞减少住院治疗但临床状况良好的低风险癌症儿童，只要粒细胞计数在上升，无论ANC如何，都可以停止静脉抗生素治疗并安全出院。这种方法缩短了住院时间，并节省了可观的费用。
