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J Infect. 2015 Jun;71 Suppl 1:S27-35. doi: 10.1016/j.jinf.2015.04.026. Epub 2015 Apr 25.

Febrile neutropenia in children treated for malignancy.

Author information

1
Department of Haematology & Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, United Kingdom. Electronic address: christopherbarton@nhs.net.
2
Department of Haematology & Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom. Electronic address: lucy.waugh@alderhey.nhs.uk.
3
Department of Haematology & Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom. Electronic address: maryke.nielsen@alderhey.nhs.uk.
4
Department of Infectious Diseases, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom; Institute of Global Health, University of Liverpool, Liverpool L69 3BX, United Kingdom. Electronic address: stephane.paulus@alderhey.nhs.uk.

Abstract

Febrile neutropenia (FN) in children treated for malignancy is a common and direct sequela of chemotherapy. Episodes of FN can be life-threatening, and demand prompt recognition, assessment and treatment with broad spectrum antibiotics. While in the majority of episodes no causal infection is identified, 10-20% are secondary to a bloodstream infection (BSI). A reduction in episodes of BSI could be achieved through robust infection prevention strategies, such as CVL care bundles. Alongside good antimicrobial stewardship, these strategies could reduce the risk of emergent, multi-drug resistant (MDR) infections. Emerging bacterial pathogens in BSI include Viridans Group Streptococci (VGS) and Enterobacteriaceae such as Klebsiella spp. which are known for their ability to carry MDR genes. There is also increased recognition of the role of invasive fungal infection (IFI) in FN, in particular with Aspergillus spp. Novel diagnostics, including multiplex blood and respiratory polymerase chain reaction assays can identify infections early in FN, facilitating targeted therapy, and reducing unnecessary antimicrobial exposure. Given appropriate, and sensitive rapid diagnostics, potential also exists to safely inform the risk assessment of patients with FN, identifying those at low risk of complication, who could be treated in the out-patient setting. Several clinical decision rules (CDR) have now been developed and validated in defined populations, for the risk assessment of children being treated for cancer. Future research is needed to develop a universal CDR to improve the management of children with FN.

KEYWORDS:

Febrile neutropaenia; Malignancy; Neutropenic sepsis; Paediatrics

PMID:
25917801
DOI:
10.1016/j.jinf.2015.04.026
[Indexed for MEDLINE]

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