Yıl: 2010 Cilt: 4 Sayı: 1 Sayfa Aralığı: 1 - 8 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Febrile neutropenic episodes in children with lymphoma and malignant solid tumors

Öz:
Amaç: Lenfoma ve malin solid tümör (MST) tanılı çocuklarda gelişen febril nötropenik atakların (FNA) değerlendirilmesi. Yöntemler: 01 Haziran 2005-01 Ağustos 2007 tarihleri arasında onkolojik tedavi uygulanan, FNA gelişen çocukların dosyaları incelendi. Nötropeni, mutlak nötrofil sayısının <500 hücre/mm3 olması veya <1000 hücre/mm3 olup 24-48 saat içinde <500 hücre/mm3’ e düşmesinin beklenmesi; ateş, aksiller ölçüm ile bir kez ≥38.5°C veya 1 saat süreyle ≥38°C veya en az 4 saat arayla ardışık iki kez ≥38°C ölçülmesi olarak tanımlandı. Bulgular: Otuzüç hastada gelişen 73 febril nötropenik atak (FNA) değerlendirildi. Ortanca tanı yaşı 6 y (5ay-18y), E:K oranı 2 idi. Onkolojik tanıların %24’ü lenfoma, %76’sı maliyn solid tümörler (MST) olup, FNA’ların %77’si MST hastalarında gelişmişti. Atakların %78’inden önce hastalar proflaktik G-CSF kullanmışlardı. Febril nötropenik atakların %55’i klinik, %16’sı mikrobiyolojik olarak dökümante edilmişti. İzole edilen mikroorganizmalar %85 oranında Gram (-) bakterilerdi. Empirik tedavide %22 tek, %48 iki, %22 üç, %8’inde üçün üzerinde sayıda antibiyotik uygulanmıştı. Empirik tedavide FNA’ların 39’unda sefalosporinler, 34’ünde karbapenemler verilmişti. Antibiyotik modifikasyonu FNA’ların %22’sinde gerekmişti. Glikopeptidler %35, antifungaller %20, antiviraller %5 oranlarında FNA’larda uygulanmıştı. Ateş kontrolü ortanca 48 saatte (1-18 gün) sağlanmıştı. Febril nötropenik atakların %42’sinde 7 günden önce parenteral antibiyotik tedavisi kesilip, ağızdan sefiksim tedavisine geçilmişti. Parenteral antibiyotik tedavisinin süresi FNA’ların %14’ünde 10 günden uzun süreliydi. Beş FNA’ da şok gelişmişti. Sonuç: Febril nötropenik atakların %22’si tek antibiyotikle tedavi edildi ve %42’sinde parenteral antibiyotikler bir haftadan kısa süreli kullanıldı. Hastaların çoğunluğu 10 günden kısa süre hastanede yatırılarak tedavi edildi. Gerek ateşin kontrol edilme zamanı, gerekse antibiyotik modifikasyon oranı sefalosporin ve karbapenem grupları arasında farklı bulunmadı.
Anahtar Kelime:

Konular: Enfeksiyon Hastalıkları

Lenfoma ve solid malin tümör tanılı çocuklarda gelişen febril nötropenik ataklar

Öz:
Objective: To analyze febrile neutropenic episodes (FNEs) of children with lymphoma and malignant solid tumors (MSTs). Methods: Medical records of children with cancer who had FNEs between July 01, 2005-August 01, 2007 were analyzed. Neutropenia was defined as an absolute neutrophil count (ANC) of <500 cells/mm3 or a count of <1000 cells/ mm3, with a predicted decrease to <500 cells/ mm3 within 24-48 h. Fever was defined as a single axillary temperature &#8805;38.5°C, or &#8805;38°C for 1 h, or &#8805;38°C in two consecutive measurements with at least 4h interval. Results: Seventy-three febrile neutropenic episodes in 33 children were analyzed. The median age of diagnosis was 6 years (5 months-18years), M:F ratio was 2. The diagnosis was lymphoma in 24%, malignant solid tumors (MSTs) in 76%, and 77% of FNEs occurred in patients with MSTs. Patients received prophylactic G-CSF before 78% of the episodes. Clinical and microbiological documentation was available in 55% and 16% of FNEs, respectively. Isolated microorganisms were mostly (85%) gram (-) bacteria. Empirical treatment was monotherapy in 22%, duotherapy in 48%, three antibiotics in 22%, more than three antibiotics in 8%. As empirical therapy, 39 patients received cephalosporins, 34 patients received carbapenems. Antibiotic modification was required in 22%. Overall, glycopeptides, antifungal and antiviral agents were used in 35%, 20% and 5% of FNEs, respectively. Fever was controlled within a median of 48h (1-18 days). Parenteral antibiotics were switched to oral cefixime before 7th day of the treatment in 42% of FNEs. Parenteral antibiotherapy duration was >10days in 14% of FNEs. Shock developed in 5 FNEs. Conclusion: Twenty-two percent of FNEs were treated with monotherapy, and in 42% of episodes, parenteral antibiotics were used for less than one week. The majority of patients were hospitalized for less then 10 days. Neither fever control time, nor antibiotic modification rate was different in the cephalosporin and carbapenem groups.
Anahtar Kelime:

Konular: Enfeksiyon Hastalıkları
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA Güneş D, MUTAFOĞLU K, ÇETİNKAYA H, ARSLAN H, Çakır D, Olgun N (2010). Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. , 1 - 8.
Chicago Güneş Dilek,MUTAFOĞLU Kamer,ÇETİNKAYA Hilal,ARSLAN Hatice,Çakır Deniz,Olgun Nur Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. (2010): 1 - 8.
MLA Güneş Dilek,MUTAFOĞLU Kamer,ÇETİNKAYA Hilal,ARSLAN Hatice,Çakır Deniz,Olgun Nur Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. , 2010, ss.1 - 8.
AMA Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. . 2010; 1 - 8.
Vancouver Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. . 2010; 1 - 8.
IEEE Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N "Febrile neutropenic episodes in children with lymphoma and malignant solid tumors." , ss.1 - 8, 2010.
ISNAD Güneş, Dilek vd. "Febrile neutropenic episodes in children with lymphoma and malignant solid tumors". (2010), 1-8.
APA Güneş D, MUTAFOĞLU K, ÇETİNKAYA H, ARSLAN H, Çakır D, Olgun N (2010). Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. Çocuk Enfeksiyon Dergisi, 4(1), 1 - 8.
Chicago Güneş Dilek,MUTAFOĞLU Kamer,ÇETİNKAYA Hilal,ARSLAN Hatice,Çakır Deniz,Olgun Nur Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. Çocuk Enfeksiyon Dergisi 4, no.1 (2010): 1 - 8.
MLA Güneş Dilek,MUTAFOĞLU Kamer,ÇETİNKAYA Hilal,ARSLAN Hatice,Çakır Deniz,Olgun Nur Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. Çocuk Enfeksiyon Dergisi, vol.4, no.1, 2010, ss.1 - 8.
AMA Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. Çocuk Enfeksiyon Dergisi. 2010; 4(1): 1 - 8.
Vancouver Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. Çocuk Enfeksiyon Dergisi. 2010; 4(1): 1 - 8.
IEEE Güneş D,MUTAFOĞLU K,ÇETİNKAYA H,ARSLAN H,Çakır D,Olgun N "Febrile neutropenic episodes in children with lymphoma and malignant solid tumors." Çocuk Enfeksiyon Dergisi, 4, ss.1 - 8, 2010.
ISNAD Güneş, Dilek vd. "Febrile neutropenic episodes in children with lymphoma and malignant solid tumors". Çocuk Enfeksiyon Dergisi 4/1 (2010), 1-8.