A prospective study of admissions for febrile neutropenia in secondary paediatric units in South East England.
BACKGROUND
The Paediatric Oncology Centres (POCs) treating childhood cancer in South East England produce unified supportive care guidelines for use in the secondary pediatric (shared care) units. This study evaluated the adherence to current guidelines for febrile neutropenia (FN) and documented outcome in terms of bacterial isolates, antibiotic resistance patterns, length of hospital stay, and mortality.


METHODS
Prospective study of pediatric FN admissions between July 2001 and December 2002.


RESULTS
Data were received on 433 eligible FN episodes in 212 patients. The recommended empirical antibiotics (piptazobactam + gentamicin) were used in 354 (82%) admissions. Blood cultures were positive in 129 episodes (30%). Gram-positive organisms predominated (120/149 organisms isolated) and the majority were coagulase-negative Staphylococci (95/120). There were 27 Gram-negative isolates and 1 fungal isolate. No Gram-negative isolate was resistant to both first-line antibiotics. Only one death was recorded in the study group. The median length of hospital stay was 5 days.


CONCLUSIONS
We obtained data on a large number of shared care episodes of FN. The antibiotic guidelines were followed in most episodes. Bacteremia was common, but little resistance to first-line antibiotics was documented among Gram-negative isolates, confirming the safety of the strategy in our population.
Duncan
C
C
Children's Unit, Royal Marsden Hospital, Sutton, United Kingdom.
Chisholm
J C
JC
Freeman
S
S
Riley
U
U
Sharland
M
M
Pritchard-Jones
K
K
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004739:England / Q000453:epidemiology; D005260:Female; D005334:Fever; D005658:Fungi / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000453:epidemiology* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D000900:Anti-Bacterial Agents