Infectious events in pediatric patients with acute lymphoblastic leukemia/lymphoma undergoing evaluation for fever without severe neutropenia.
Infectious events in pediatric patients with acute lymphoblastic leukemia/lymphoma undergoing evaluation for fever without severe neutropenia.
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DOI：
10.1002/cncr.34476
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发表时间：
2022-12-01
期刊：
影响因子：
6.2
通讯作者：
Miller, Tamara P.
中科院分区：
文献类型：
--
作者：
Patel, Pratik A.;DeGroote, Nicholas P.;Jackson, Kasey;Cash, Thomas;Castellino, Sharon M.;Jaggi, Preeti;Esbenshade, Adam J.;Miller, Tamara P.
在小儿急性淋巴细胞白血病/淋巴瘤（ALL/LLy）治疗期间，感染会导致显着的治疗相关发病率。在没有严重中性粒细胞减少症的时期发烧很常见，但病因尚不清楚。本研究旨在描述接受 ALL/LLy 治疗的儿童的血流感染 (BSI) 和非 BSI 风险。提取了两家儿童医院无严重中性粒细胞减少症的发热发作的人口统计和临床数据。治疗过程按强度分层。多变量逻辑回归评估了与感染相关的特征。 524 名患者共出现 1591 次发热。其中，536 次 (34%) 次感染≥1 次； BSI 发生 30 次 (1.9%)。最近接受过镇静或阿糖胞苷治疗的发作中没有发生 BSI。低血压、寒战/寒战、体温升高和婴儿表型与 BSI 独立相关 (p < .05)。在 572 例非 BSI 中，最常见的是上呼吸道感染 (URI)（n = 381，67%）。与无感染的发作相比，URI 症状、较高的体温、绝对中性粒细胞计数 500−999/μl 以及低强度治疗过程中的评估更有可能与非 BSI 相关 (p < .05)，而住院状态不太可能与非 BSI 相关 (p < .05)。患有 ALL/LLy 且发热且无严重中性粒细胞减少症的儿科患者的 BSI 发生率较低，但三分之一的患者患有非 BSI。未来的研究应该测试是否可以根据本研究中确定的关联来调整经验性抗生素的需求。
Infections cause significant treatment-related morbidity during pediatric acute lymphoblastic leukemia/lymphoma (ALL/LLy) therapy. Fevers during periods without severe neutropenia are common, but etiologies are not well-described. This study sought to describe the bloodstream infection (BSI) and non-BSI risk in children undergoing therapy for ALL/LLy. Demographic and clinical data were abstracted for febrile episodes without severe neutropenia at two children’s hospitals. Treatment courses were stratified by intensity. Multivariate logistic regression evaluated characteristics associated with infection. There were 1591 febrile episodes experienced by 524 patients. Of these, 536 (34%) episodes had ≥1 infection; BSI occurred in 30 (1.9%) episodes. No BSIs occurred in episodes with a recent procedural sedation or cytarabine exposure. Presence of hypotension, chills/rigors, higher temperature, and infant phenotype were independently associated with BSI (p < .05). Of the 572 non-BSIs, the most common was upper respiratory infection (URI) (n = 381, 67%). Compared to episodes without infection, URI symptoms, higher temperature, absolute neutrophil count 500−999/μl, and evaluation during a low-intensity treatment course were more likely to be associated with a non-BSI (p < .05) and inpatient status was less likely to be associated with a non-BSI (p < .05). The BSI rate in pediatric patients with ALL/LLy and fever without severe neutropenia is low, but one-third of the time, patients have a non-BSI. Future research should test if the need for empiric antibiotics can be tailored based on the associations identified in this study.
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影响因子：
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