Abstract
Introduction: Febrile neutropenia in pediatric patients with oncological disease, is a common condition leading to high morbidity and mortality. The main cause is infection, meriting a timely and comprehensive study to identify its source and begin an early and a targeted therapy, it is necessary to know about this disease and its management. Objective: Perform a current review of this pathology by addressing its epidemiology, etiology, clinical diagnosis and treatment. Methods: Search in database like Cochrane Library, Medscape, Pubmed, RIMA, Ebscohost, HINARI, Dynamed, NEJM, using keywords like neutropenia, fever, infection, risk, neoplasia and treatment. We selected clinical practice guidelines, systematic reviews and randomized clinical trials. Discussion: It is a common situation mainly in patients with hematological malignancy and the cause of the fever is due to an infection whose etiologic agent varies according to origin of the case, use of intravenous catheters or prolonged and deep neutropenia. The diagnostic approach must be through physical examination and the use of diagnostic tools such blood count, acute phase reactants and polyculture. The use of prognostic models for risk stratification allows to guide the antibiotic treatment. Conclusion: Improving the knowledge of this disease, the diagnosis and treatment strategies, it has been able to improve survival and prognosis of this disease. MÉD UIS. 2015;28(3):353-62.
References
Uribe C, Amado A, Ramírez G, Alarcón I. Cáncer infantil en el área metropolitana de Bucaramanga 2003-2007. MedUNAB. 2011;14(2):86-93.
Santolaya M, Rabagliati R, Bidart T, Payá E, Guzmán A, Morales R, et al. Consenso Manejo racional del paciente con cáncer, neutropenia y fiebre. Rev Chil Infect. 2005;22(Supl 2):S79-S113.
Gençer S, Slepçi T, Ozer S. Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients. J Infect. 2003; 47(1): 65-72.
Phillips B, Wade R, Stewart LA, Sutton AJ. Systematic review and meta-analysis of the discriminatory performance of risk prediction rules in febrile neutropaenic episodes in children and young people. Eur J Cancer. 2010;46(16):2950-64.
Matloob M, Fadoo Z. Febrile neutropenia in pediatric cancer patients: Experience from a tertiary health care facility of Pakistan. Pediatr Infect Dis J. 2014;6(3):89-93.
Gupta S, Bonilla M, Gamero M, Fuentes SL, Caniza M, Sung L. Microbiology and mortality of pediatric febrile neutropenia in El Salvador. J pediatr Hematol Oncol. 2011;33(4):276-80.
Meckler G, Lindemulder S. Fever and neutropenia in pediatric patients with cancer. Emerg Med Clin N Am. 2009;27:525-44.
Phillips RS, Sutton AJ, Riley RD, Chisholm, J C, Picton SV, Stewart LA. Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol). Systematic Reviews. 2012;1:8.
Comité Nacional de Infectología Pediátrica. Consenso sobre el cuidado del paciente oncológico neutropénico febril. Actualización 2008-2009. Arch Argent Pediatr. 2010;108(2)47-70.
Jaramillo C, Valencia IC, Aristizábal MA. Neutropenia febril en pacientes pediátricos: un enfoque diagnóstico y terapéutico. Iatreia. 2009;22(3):235-45.
Rueda E, Trujillo ML, Díaz LA. La neutropenia severa febril en niños con cáncer. Estudio descriptivo en el Hospital Universitario de Santander. Salud UIS. 2010;42:103-11.
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer. Clinical InfectiousDiseases. 2011;52:e56-e93.
Ke ZY, Xu L, Zhang TT, Mo YL, Huang LB, Zhang XL, et al. A prospective study of febrile episodes in inpatient children on chemotherapy. Pediatr Infect Dis J. 2010;29(10):968-70.
Klaassen RJ, Goodman TR, Pham B, Doyle JJ. “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol. 2000;18(5):1012-9.
Ramírez-Londoño LM, Blanco-Villamizar N, Hernández-Escobar M, Sierra-Sánchez M, Aristizábal-Gil MA, Peña-Siado J, et al. Episodios de neutropenia febril en niños con neoplasias malignas. Infectio. 2003;7(3):137-46.
Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol. 2005;23(31):7958-66.
Tezcan G, Kupesiz A, Ozturk F, Ogunc D, Gultekin M, Yesilipek A, et al. Episodes of fever and neutropenia in children with cancer in a tertiary care medical center in Turkey. Pediatr Hematol Oncol. 2006;23(3):217-29.
Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol. 2008,25(5):385-92.
Klaassen IL, de Haas V, van Wijk JA, Kaspers GJ, Bijlsma M, Bökenkamp A. Pyuria is absent during urinary tract infections in neutropenic patients. Pediatr Blood Cancer. 2011;56(5):868-70.
Santolaya ME, Farfán MJ, De La Maza V, Cociña M, Santelices F, Alvarez AM, et al. Diagnosis of bacteremia in febrile neutropenic episodes in children with cancer: microbiologic and molecular approach. Pediatr Infect Dis J. 2011;30(11):957-61.
Paul M, Gafter-Gvili A, Leibovici L, Bishara J, Levy I, Yaniv I,et al. The epidemiology of bacteremia with febrile neutropenia: experience from a single center, 1988-2004. Isr Med Assoc J.2007;9(6):424-9.
Lucero A Yalda, Brücher U Roberto, Alvarez P Ana María, Becker K Ana, Cofré G José, Enríquez O Nancy, et al. Infección micótica profunda en niños con cáncer, neutropenia y fiebre, en Chile. Rev. méd. Chile. 2002;130(10):1139-46.
Urabe A. Clinical features of the neutropenic host: definitions and initial evaluation. Clin Infect Dis. 2004;39(Suppl 1):S53-5.
Rackoff WR, Gonin R, Robinson C, Kreissman SG, Breitfeld PB. Predicting the risk of bacteremia in childen with fever and neutropenia. J Clin Oncol. 1996;14(3):919-24
Martinez-Albarran M, Perez-Molina Jde J, Gallegos-Castorena S, Sanchez-Zubieta F, Del Toro-Arreola S, Troyo-Sanroman R et al. Procalcitonin and C-Reactive Protein Serum Levels As Markers of Infection in a Pediatric Population With Febrile Neutropenia and Cancer. Pediatr Hematol Oncol. 2009;26:414-25.
Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008;36(5):396-407.
National Institute for Health and Care Excellence. Neutropenic sepsis : prevention and management of neutropenic sepsis in cancer patients. 2012 [Consultado: 04 Oct de 2015]. Disponible en:https://www.nice.org.uk/guidance/cg151/resources/guidanceneutropenic-sepsis-prevention-and-management-of-neutropenicsepsis-in-cancer-patients-pdf.
Glasmacher A, Von Lilienfeld-Toal M, Schulte S, Hahn C, SchmidtWolf IG, Preatice A. An evidence-based evaluation of important aspects of empirical antibiotic therapy in febrile neutropenic patients. Clin Microbiol Infect. 2008;11 Supl 5:17-23.
Sharma A, Lokeshwar N. Febrile neutropenia in haematological malignancies. J postgrad med. 2005;51 Supl 1:S42-8.
Klastersky JA. Use of imipenem as empirical treatment of febrile neutropenia. Int J Androl. 2003;21(5):393-402.
Abhijit M, Gould I. Empirical antimicrobial treatment for chemotherapy-induced febrile neutropenia. International journal of antimicrobial agents. 2007;29(5):501-9.
Giurici N, Zanazzo G. Consensus on dia gnosis and empiricantibiotic therapy of febrile neutropenia. Pediatric Rep. 2011;3(1):e4.
Rivera AN, Boucher HW. Current Concepts in Antimicrobial Therapy Against Select Gram-Positive Organisms : MethicillinResistant Staphylococcus aureus, Penicillin-Resistant Pneumococci, and Vancomycin-Resistant Enterococci. Mayo
Clin Proc. 2011;86(12):1230-43.
Cometta A, Kern WV, De Bock R, Paesmans M, Vandenbergh M, Crokaert F, et al. Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clinical infectious
diseases. 2003;37(3):382-89.
Freifeld A, Marchigiani D, Walsh T, Chanock S, Lewis L, Hiemenz S, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999;341(5):305-11.
Welte K, Gabrilove J, Bronchud MH, Platzer E, Morstyn G. Filgrastim (r-metHuG-CSF): the first 10 years. Blood. 1996;88(6):1907–29.