title: Asymptomatic C-reactive protein elevation in neutropenic children.
abstract: BACKGROUND
  Febrile neutropenia (FN) can be a life-threatening complication in children with malignancies. There is no standardized preventive treatment for childhood FN, and information on C-reactive protein (CRP) elevation in afebrile patients with neutropenia (CEAN) is limited. The aim of this study was therefore to identify the association between CEAN and FN onset, and evaluate the efficacy of broad-spectrum antibiotics for FN prophylaxis.
  
  
  METHODS
  We retrospectively reviewed the medical records of 22 consecutive pediatric patients with hematologic malignancies (acute myeloid leukemia, n = 2; acute lymphoid leukemia, n = 20) admitted to the present institution between 2006 and 2011. CEAN was defined as CRP elevation ≥0.05 mg/dL between the two most recent blood tests with no fever. We identified CEAN before FN onset, and assessed the efficacy of broad-spectrum antibiotics for FN prevention in CEAN. FN incidence within 48 h after CEAN detection was compared between prophylactic and non-prophylactic episodes.
  
  
  RESULTS
  CEAN was observed before FN onset in 20 (55.6%), of 36 FN episodes. Among the 95 analyzed CEAN episodes, broad-spectrum antibiotics had been used for 30 episodes (prophylactic episodes), whereas these antibiotics had not been used in 60 episodes (non-prophylactic episodes). Prophylactic episodes had a significantly lower FN incidence than non-prophylactic episodes (6.7% and 31%, respectively, P < 0.01) within 48 h after CEAN detection. Bacteremia was observed in three non-prophylactic episodes.
  
  
  CONCLUSIONS
  Patients with CEAN are at higher risk of FN, and physicians may consider the use of broad-spectrum antibiotics to prevent FN development.
authors.affiliation: Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.|Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Sugiura
authors.affiliation: Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Koyama
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Sasaki
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikai
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D064147:Febrile Neutropenia / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000097:blood* / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: C-reactive protein; broad-spectrum antibiotic; febrile neutropenia; prophylaxis