Fever in neutropenia in children and adolescents: evolution over time of main characteristics in a single center, 1993-2001.
OBJECTIVE
To assess the evolution over time of main characteristics of episodes of fever in severe chemotherapy-induced neutropenia (FN) in children and adolescents with cancer treated for FN following nonmyeloablative chemotherapy, to compare the results with the experiences of other centers, and to assess the impact of the changes found on management of FN and on risk prediction rules.


METHODS
Retrospective cohort study of all children and adolescents up to 18 years presenting with FN in a single pediatric oncology unit between 1993 and 2001.


RESULTS
In 132 patients, 364 episodes of FN were reported. The relative incidence of FN increased significantly over time in patients with precursor B-cell acute lymphoblastic leukemia (PBC-ALL), reflecting the increased intensity of chemotherapy. At presentation with FN, the proportions of patients (1) with PBC-ALL versus other malignancies, (2) with other malignancies being in complete remission, (3) with a central venous catheter, and (4) with shaking chills all significantly increased over time (overall proportions, 64%, 60%, 50%, and 5%, respectively; p <0.001 for all). In 337 (93%) episodes, ceftriaxone plus amikacin was used as empirical broad spectrum antimicrobial therapy.


CONCLUSIONS
This study demonstrates that some characteristics of FN, though not necessarily its management, change over time, implying regular update of risk prediction rules. In contrast to other centers, the first-line antimicrobial therapy did not need modification because of changing resistance patterns.
Ammann
Roland A
RA
Division of Pediatric Hematology and Oncology, University Children's Hospital, University of Bern, Bern, Switzerland. roland.ammann@insel.ch
Aebi
Christoph
C
Hirt
Andreas
A
Ridolfi Lüthy
Annette
A
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015448:Leukemia, B-Cell / Q000188:drug therapy; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000453:epidemiology*; D016012:Poisson Distribution; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology