Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia
Background: Antibiotics have been widely and efficaciously used for febrile neutropenia in pediatric patients. However, reports are scant regarding the risk factors for recurrent fever after discontinuation of antibiotics in a neutropenic state. Here, we investigated these factors using data from ou...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Journal of Microbiology, Immunology and Infection |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118220301754 |
| _version_ | 1819174394169131008 |
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| author | Ryoji Kobayashi Satoru Matsushima Daiki Hori Hirozumi Sano Daisuke Suzuki Kenji Kishimoto Kunihiko Kobayashi |
| author_facet | Ryoji Kobayashi Satoru Matsushima Daiki Hori Hirozumi Sano Daisuke Suzuki Kenji Kishimoto Kunihiko Kobayashi |
| author_sort | Ryoji Kobayashi |
| collection | DOAJ |
| description | Background: Antibiotics have been widely and efficaciously used for febrile neutropenia in pediatric patients. However, reports are scant regarding the risk factors for recurrent fever after discontinuation of antibiotics in a neutropenic state. Here, we investigated these factors using data from our previously reported randomized study regarding meropenem and piperacillin/tazobactam for pediatric patients with febrile neutropenia. Procedure: We analyzed a total of 170 febrile episodes where first line antibiotic treatment was effective and discontinued before neutrophil recovery. Results: Recurrent fever was observed in 31 episodes (18%). The median interval from antibiotics discontinuation to recurrent fever was 5 days (0–27 days). Risk factors for recurrent fever were: incomplete remission of original disease; and high white blood cell count, neutrophil count, and C reactive protein levels at start of antibiotics. Moreover, lower neutrophil count at discontinuation of antibiotics, duration of neutropenia, and onset day of febrile neutropenia from start of neutropenia were also risk factors of recurrent fever. In multivariate analysis, neutrophil count at discontinuation of antibiotics <0.011 × 109/L, neutrophil count at start of antibiotics ≥0.061 × 109/L, febrile onset following <1 day after onset of neutropenia, and incomplete remission of original disease were independent risk factors for recurrent fever. Conclusions: Discontinuation of antibiotics while pediatric patients were still neutropenic was almost safe. However, physicians should note the risk factors of recurrent fever. |
| first_indexed | 2024-12-22T20:38:16Z |
| format | Article |
| id | doaj.art-9a1f58627c3340509a1d386ec8213898 |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-12-22T20:38:16Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-9a1f58627c3340509a1d386ec82138982022-12-21T18:13:25ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822021-12-0154610561060Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropeniaRyoji Kobayashi0Satoru Matsushima1Daiki Hori2Hirozumi Sano3Daisuke Suzuki4Kenji Kishimoto5Kunihiko Kobayashi6Corresponding author. Department of Hematology, Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishiku, Sapporo 003-0006, Japan. Fax: +81 11 865 9719.; Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanDepartment of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, JapanBackground: Antibiotics have been widely and efficaciously used for febrile neutropenia in pediatric patients. However, reports are scant regarding the risk factors for recurrent fever after discontinuation of antibiotics in a neutropenic state. Here, we investigated these factors using data from our previously reported randomized study regarding meropenem and piperacillin/tazobactam for pediatric patients with febrile neutropenia. Procedure: We analyzed a total of 170 febrile episodes where first line antibiotic treatment was effective and discontinued before neutrophil recovery. Results: Recurrent fever was observed in 31 episodes (18%). The median interval from antibiotics discontinuation to recurrent fever was 5 days (0–27 days). Risk factors for recurrent fever were: incomplete remission of original disease; and high white blood cell count, neutrophil count, and C reactive protein levels at start of antibiotics. Moreover, lower neutrophil count at discontinuation of antibiotics, duration of neutropenia, and onset day of febrile neutropenia from start of neutropenia were also risk factors of recurrent fever. In multivariate analysis, neutrophil count at discontinuation of antibiotics <0.011 × 109/L, neutrophil count at start of antibiotics ≥0.061 × 109/L, febrile onset following <1 day after onset of neutropenia, and incomplete remission of original disease were independent risk factors for recurrent fever. Conclusions: Discontinuation of antibiotics while pediatric patients were still neutropenic was almost safe. However, physicians should note the risk factors of recurrent fever.http://www.sciencedirect.com/science/article/pii/S1684118220301754DiscontinuationMeropenemPiperacillin/tazobactamFebrile neutropenia |
| spellingShingle | Ryoji Kobayashi Satoru Matsushima Daiki Hori Hirozumi Sano Daisuke Suzuki Kenji Kishimoto Kunihiko Kobayashi Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia Journal of Microbiology, Immunology and Infection Discontinuation Meropenem Piperacillin/tazobactam Febrile neutropenia |
| title | Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia |
| title_full | Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia |
| title_fullStr | Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia |
| title_full_unstemmed | Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia |
| title_short | Analysis of antibiotics discontinuation during bone marrow suppression in childhood, adolescent and young adult patients with febrile neutropenia |
| title_sort | analysis of antibiotics discontinuation during bone marrow suppression in childhood adolescent and young adult patients with febrile neutropenia |
| topic | Discontinuation Meropenem Piperacillin/tazobactam Febrile neutropenia |
| url | http://www.sciencedirect.com/science/article/pii/S1684118220301754 |
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