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Neutropenia febril de bajo riesgo en pacientes oncológicos Low risk febrile neutropenia in oncological pediatric patients: clinical experience
CLAUDIA ROJO L,NATALIE RODRíGUEZ Z,JUAN TORDECILLA C
Revista chilena de pediatría , 2008,
Abstract: Las infecciones son la principal causa de morbimortalidad en pacientes oncológicos en quimioterapia. El Comité de Infectología del PINDA (Programa Infantil Nacional de Drogas Antineoplásicas) validó un modelo de predicción de riesgo de infección bacteriana invasora (IBI) en ni os oncológicos con neutropenia febril (NF), que discrimina episodios de bajo (NFBR) y alto riesgo (NFAR) de IBI. Objetivo: Caracterizar los episodios de NFBR de pacientes atendidos en la Unidad de Oncología del Hospital de Ni os Roberto del Río (2003-2006). Pacientes y Métodos: Revisión retrospectiva de fichas clínicas de pacientes que debutaron con patología oncológica en ese período que presentaron episodios de NFBR consignando edad, sexo, diagnóstico oncológico de base, catéter venoso central, foco infeccioso, quimioterapia y cultivos. Se evaluó la evolución clínica por parámetros clínicos y de laboratorio, y se analizaron las variables mediante prueba de , con un p < 0,05. Resultados: En 185 pacientes, se registraron 202 episodios de NF, 47 fueron NFBR (23%). Presentaron evolución desfavorable un 8,5% de NFBR (p > 0,05). En ellos no se logró aislamiento microbiológico y tuvieron mayor número de días de hospitalización. No hubo en este grupo reingresos ni mortalidad asociada. Conclusión: El manejo selectivo de los pacientes con NFBR, según criterios actuales, es seguro y efectivo Background: Infections constitute the major cause of morbimortality in pediatric patients treated with chemotherapy. The PINDA Infectology Committee (National Program of Antineoplasic Drugs) validated a model to predict the risk of invasive bacterial infection (IBI) in oncological patients with febrile neutropenia (FN), in order to differentiate episodes of low risk (LRFN) versus high risk (HRFN) of IBI. Objective: Characterize LRFN episodes in patients treated at the Oncology Unit of Hospital Roberto del Rio, between 2003-2006. Method: Retrospective study of clinical charts of patients with cancer and LRFN in the period of time selected. Results: 185 patients with 202 FN episodes registered, where 47 correspond to LRFN (23%). 8.5% of LRFN episodes had an unfavourable outcome (not statistically significant). In these patients, cultures were negative and required more days of hospitalization. No patients were readmitted and had no infection associated mortality. Conclusion: The selective management of patients with LRFN following the current criteria is safe and effective
NEUTROPENIA FEBRIL EN PEDIATRIA Febrile Neutropenia in Pedriatrics  [cached]
Pio Lopez,Eduardo Lopez
Infectio , 2008,
Abstract: La neutropenia febril es una condición frecuente en los pacientes pediátricos con cáncer. En el momento en que se hace este diagnóstico, el médico debe conducir una entrevista y un examen físico rigurosos, obtener cultivos e iniciar antibióticos para combatir un amplio espectro de microorganismos. La decisión de suspender los antibióticos se debe basar en el conteo de neutrófilos, la persistencia de la fiebre y la presencia o ausencia de factores de riesgo. Presentamos una revisión reciente de la literatura en esta condición tan frecuentemente asociada con morbimortalidad en ni os. Febrile neutropenia is a frequent condition among pediatric patients with cancer. When this diagnosis is made, the physician must conduct a thorough interview and physical exam, cultures need to be obtained and antibiotics started to cover a wide spectrum of microorganisms. The decision of stopping antibiotics must be made based on the neutrophile count, the persistence of fever and the presence or absence of risk factors. We present a current review of the literature on this condition so highly associated with morbimortality in children.
NEUTROPENIA FEBRIL EN PEDIATRIA
Lopez,Pio; Lopez,Eduardo;
Infectio , 2008,
Abstract: febrile neutropenia is a frequent condition among pediatric patients with cancer. when this diagnosis is made, the physician must conduct a thorough interview and physical exam, cultures need to be obtained and antibiotics started to cover a wide spectrum of microorganisms. the decision of stopping antibiotics must be made based on the neutrophile count, the persistence of fever and the presence or absence of risk factors. we present a current review of the literature on this condition so highly associated with morbimortality in children.
La neutropenia severa febril en ni os con cáncer: Estudio descriptivo en el Hospital Universitario de Santander Severe febrile neutropenia in children with cancer: A descriptive study at the Hospital Universitario de Santander  [cached]
Ernesto Rueda,Magda Lucero Trujillo,Luis Alfonso Díaz
Revista de la Universidad Industrial de Santander. Salud , 2010,
Abstract: Objetivos: Describir una población oncológica afectada por neutropenia severa febril, sus características demográficas, nutricionales, microbiológicas, de tratamiento y severidad de la enfermedad. Materiales y métodos: Esta es una serie de casos prospectiva de los pacientes atendidos en el Hospital Universitario de Santander entre enero/2007 y enero/2008. Resultados: Veintiun (21) pacientes aportaron 35 episodios de neutropenia febril; 65,7% eran hombres, la edad promedio 5,6 a os; 38,3% vivían en el área Metropolitana de Bucaramanga y 91,4% en estrato socioeconómico bajo. El diagnóstico oncológico más frecuente fue leucemia linfocítica aguda. Ninguno presentó dolor abdominal o síntomas neurológicos. La neutropenia se detectó 8,5 días en promedio posterior a la última quimioterapia. El 31,4% no tuvieron neutrófilos absolutos, 54,2% plaquetas <50,000/mm3, 45,7% proteína C reactiva <90 mg/dL. Los hemocultivo fueron positivos en siete pacientes. Se encontró foco de infección en 88,6% de los episodios y los diagnósticos más frecuentemente estuvieron relacionados con el tracto gastrointestinal. El antibiótico más utilizado en la terapia empírica fue oxacilina+amikacina (71,4% de los episodios), pero con necesidad de cambio en el 40%. La letalidad fue de 4,8%. En promedio se ocuparon 1,48 camas/día para el manejo de esta patología. Conclusiones: Los pacientes con neutropenia febril presentan múltiple factores que pueden indicar infección bacteriana. Se deben indagar los factores asociados con la neutropenia y la flora bacteriana de cada institución. Muchos pacientes necesitaron cambio de antibiótico, por lo que es necesario determinar el mejor esquema empírico de antibióticos. Salud UIS 2010; 42: 103-111 Objective: To describe an oncological population affected with severe febrile neutropenia, its demographic, nutritional, and microbiological features, their treatment and severity of the illness. Materials and methods: A descriptive-prospective clinical chart review from attended patients at the Hospital Universitario de Santander, from January/2007 to January/2008. Results: Twenty (21) patients contributed with 35 febrile neutropenia episodes; 65.7% were male; they aged average was 5.6-years; 38.37% lived in Bucaramanga Metropolitan Area; 91.4% had low economic status. The most frequent oncological diagnosis was acute lumphocytic leukemia. No one presented abdominal pain or neurological symptoms. The neutropenia was detected 8.5 days after the last chemotherapy cycle. 31.4% patients had no absolute neutrophils; 54.2% blood platelets <50,000/mm3, 45.7% had re
Tratamiento ambulatorio del paciente con neutropenia febril
Londo?o Gallo,Andrés;
Iatreia , 2008,
Abstract: treatment of patients with neoplasia and febrile neutropenia, as a consequence of chemotherapy, poses many doubts, among them the need for hospitalization, since this implies exposure to potentially resistant nosocomial microorganisms. even under the best isolation techniques, there may be risks for individuals whose immune system may not be in optimal conditions. multiple studies have tried to validate methods for classifying patients with febrile neutropenia according to their risk of complications. such classification systems could be the base for implementing selective treatment strategies, one of which would be the oral ambulatory administration of wide-spectrum antibiotics. neutropenia is one of the serious consequences of cancer chemotherapy, and it has been demonstrated that intravenous antibiotic treatment reduces mortality. therefore, oral therapy could constitute an acceptable alternative for well-selected patients but the need for applying good clinical judgement, properly following up patients, and the availability of immediate access to medical attention should be emphasized. the following are among the potential benefits of oral treatment: better quality of life for patients and their families, avoidance of the complications associated with intravenous therapy, and diminished costs of health care.
Novas diretrizes na abordagem clínica da neutropenia febril e da sepse em oncologia pediátrica
Mendes, Ana Verena Almeida;Sapolnik, Roberto;Mendon?a, Núbia;
Jornal de Pediatria , 2007, DOI: 10.1590/S0021-75572007000300007
Abstract: objectives: to provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. sources: a review of the scientific literature utilizing an electronic bibliographic search on medline, medscape, scielo, google, cochrane and pubmed using the keywords febrile, neutropenic, cancer, children, sepsis, intensive, care. articles published between 1987 and 2007 were selected, with preference given to review articles, protocols, systematic reviews, epidemiological studies, task force recommendations and phase iii clinical trials. consensus documents published by the infectious diseases society of america, the center for diseases control and the infectious diseases working party of the german society of hematology and oncology, in addition to the recommendations of the world federation of pediatric intensive and critical care societies and society of critical care medicine, were also reviewed. summary of the findings: the use of aggressive chemotherapy regimens, bone marrow transplantation and intensive care resources have increased the survival rates of children with cancer and also their infectious morbidity, with septic complications as the principal cause of mortality. several risk factors have been identified, such as neutropenia, oncology type, clinical signs and inflammatory response markers (polymerase chain reaction, procalcitonin) and also increased resistance to antimicrobials and antifungal agents. protocols for risk classification, diagnosis and treatment should be established at each service, taking into account the microbiological flora of each population. pediatric intensive care has increased the short and long-term survival of these patients. conclusions: oncology patients are particularly vulnerable to infectious complications. early identification and treatment are fundamental to improving survival rates.
Neutropenia febril en menores con Leucemia linfoblástica aguda Febrile neutropenia in children with acute lymphoblastic leukemia (ALL)
Amara Hormaechea S,Pilar Martínez D,Paola Zolezzi R,Isabel Folatre B
Revista chilena de pediatría , 2004,
Abstract: Introducción:La neutropenia febril es la primera manifestación de una infección potencialmente letal en pacientes en quimioterapia por cáncer. Objetivo:Analizar el perfil de los episodios de neutropenia febril en pacientes menores de 15 a os con diagnóstico de Leucemia Linfoblástica Aguda estudiados en Valdivia. Pacientes y método: Se analizaron 150 episodios de neutropenia febril en 47/51 menores de 15 a os tratados según Protocolo de Leucemia Linfoblástica Infantil, PINDA 96 MINSAL, en el Hospital Clínico Regional de Valdivia (1996-1999). Resultados: La neutropenia fue severa: RAN < 500/mm3 en el 71,4% (107/150). Se estableció el foco de origen en el 72,6% (109/150), dado por patología respiratoria en el 53,4% (80/150). Se identificó el agente infeccioso en el 29,3% (44/150), con predominio de gram (+), seguido de gram (-) y hongos. Se determinó una infección del torrente sanguíneo en el 11,4% (17/150), de éstas el 47,1% se debió a bacilos gram (-), cocáceas gram (+) 35,3%, cándida sp 11,8%, bacilos gram (+) 5,8%. El tratamiento con Cloxacilina 100 mg/kg/día/ev + Amikacina 15 mg/kg/día/ev fue efectivo en el 66% (99/150) de los episodios. Aumentó al 94% (141/150) al agregarse Ceftriaxona 100 mg/kg/día ev. Conclusiones: Se obtuvo una adecuada identificación del foco infeccioso en pacientes neutropénicos febriles portadores de Leucemia Linfoblástica Aguda, lográndose su control con el esquema antibiótico utilizado Introduction: Febrile neutropenia is the first manifestation of a life threatening infection in patients undergoing chemotherapy. Objectives: an analysis of the profile of febrile neutropenic episodes in patients under 15 years treated for ALL in Valdivia. Patients and methods: We reviewed 150 episodes in children enrolled in the ALL childrens protocol PINDA 96 MINSAL at the Regional Clinical Hospital Valdivia between 1996 and 1999. Results: 71.4% of episodes were during severe neutropenia (RAN <500/mm3). The source of the infection was established in 72.6% of cases, the most frequent focus was respiratory 53.4% (80/150). The causative organism was identified in 29.3%, with a predominance of gram + followed by gram- and fungi. 11.4% had positive blood cultures, 46% being gram -- bacilli, 34.6% gram + cocci, 11.8% Candida and 3.8% gram + bacilli. Treatment with iv cloxacillin 100 mg/kg/day and iv amikacin 15 mg/kg/day was successful in 66%, increasing to a 94% success rate with the addition of iv ceftriaxone 100 mg/kg/day. Conclusions: We obtained an appropriate identification of the infective focus in febrile neutropenic episodes in patients wi
Tratamiento ambulatorio del paciente con neutropenia febril Outpatient therapy in patients with febrile neutropenia
Andrés Londo?o Gallo
Iatreia , 2008,
Abstract: El tratamiento de los pacientes con neoplasia y neutropenia febril plantea muchas dudas. Una de ellas, que genera ansiedad en el personal de la salud, el paciente y sus familiares, es la necesidad de hospitalización porque ésta implica exponer a gérmenes intrahospitalarios potencialmente resistentes a un paciente cuyo sistema inmune puede no estar en las mejores condiciones; incluso con un aislamiento óptimo existe el riesgo de adquirir una infección nosocomial. Muchos estudios han tratado de validar métodos para clasificar a los pacientes con fiebre y neutropenia en grupos de diferente riesgo, como fundamento para implementar estrategias de tratamiento selectivo; así se ha abierto la posibilidad de utilizar medidas más conservadoras para el tratamiento de los episodios de bajo riesgo, entre ellas la administración de regímenes orales ambulatorios de antibióticos de amplio espectro; ello sin demeritar la necesidad de aplicar un juicio clínico adecuado, hacer un buen seguimiento y tener acceso a la atención médica inmediata. La neutropenia es una de las consecuencias graves de la quimioterapia para el cáncer, y se ha demostrado que el tratamiento del paciente neutropénico febril con antibióticos intravenosos reduce la mortalidad. La terapia oral podría ser una alternativa aceptable para pacientes bien seleccionados. Ella puede mejorar la calidad de vida de los pacientes con cáncer, evitar las complicaciones asociadas con la terapia intravenosa y disminuir los costos del tratamiento. Treatment of patients with neoplasia and febrile neutropenia, as a consequence of chemotherapy, poses many doubts, among them the need for hospitalization, since this implies exposure to potentially resistant nosocomial microorganisms. Even under the best isolation techniques, there may be risks for individuals whose immune system may not be in optimal conditions. Multiple studies have tried to validate methods for classifying patients with febrile neutropenia according to their risk of complications. Such classification systems could be the base for implementing selective treatment strategies, one of which would be the oral ambulatory administration of wide-spectrum antibiotics. Neutropenia is one of the serious consequences of cancer chemotherapy, and it has been demonstrated that intravenous antibiotic treatment reduces mortality. Therefore, oral therapy could constitute an acceptable alternative for well-selected patients but the need for applying good clinical judgement, properly following up patients, and the availability of immediate access to medical attention should
Neutropenia febril de bajo riesgo en pacientes oncológicos
ROJO L,CLAUDIA; RODRíGUEZ Z,NATALIE; TORDECILLA C,JUAN;
Revista chilena de pediatría , 2008, DOI: 10.4067/S0370-41062008000200005
Abstract: background: infections constitute the major cause of morbimortality in pediatric patients treated with chemotherapy. the pinda infectology committee (national program of antineoplasic drugs) validated a model to predict the risk of invasive bacterial infection (ibi) in oncological patients with febrile neutropenia (fn), in order to differentiate episodes of low risk (lrfn) versus high risk (hrfn) of ibi. objective: characterize lrfn episodes in patients treated at the oncology unit of hospital roberto del rio, between 2003-2006. method: retrospective study of clinical charts of patients with cancer and lrfn in the period of time selected. results: 185 patients with 202 fn episodes registered, where 47 correspond to lrfn (23%). 8.5% of lrfn episodes had an unfavourable outcome (not statistically significant). in these patients, cultures were negative and required more days of hospitalization. no patients were readmitted and had no infection associated mortality. conclusion: the selective management of patients with lrfn following the current criteria is safe and effective
Triagem para o tratamento ambulatorial da neutropenia febril
Bellesso, Marcelo;Costa, Silvia Figueiredo;Chamone, Dalton Alencar Fischer;Llacer, Pedro Enrique Dorlhiac;
Revista Brasileira de Hematologia e Hemoterapia , 2010, DOI: 10.1590/S1516-84842010000500014
Abstract: febrile neutropenia is a frequent and potentially fatal adverse event of chemotherapy. nowadays, febrile neutropenia is considered an emergency and it is known that prompt infusion of antibiotics decreases mortality. several studies demonstrated that febrile neutropenia is a heterogeneous group of diseases and that factors such as outpatient status, no hypotension, no dehydration, no chronic obstructive pulmonary disease, no symptoms, no previous fungal infection and age < 60 years are protective factors against serious complications as demonstrated by the multinational association for supportive care in cancer (mascc). these data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. the aim of this work is to review and discuss tools (in particular the mascc index) for safe screening of febrile neutropenia for outpatient treatment in addition to demonstrate results of research.
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