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Egreso temprano en pacientes pediátricos con cáncer, fiebre y neutropenia con bajo riesgo de infección sistémica. / Early discharge of pediatric patients with cancer, fever, and neutropenia with low-risk of systemic infection.

Gil-Veloz, Mariana; Pacheco-Rosas, Daniel O; Solórzano-Santos, Fortino; Villasís-Keever, Miguel A; Betanzos-Cabrera, Yadira; Miranda-Novales, Guadalupe.
Bol Med Hosp Infant Mex; 75(6): 352-357, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30407457

BACKGROUND:

Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI).

METHODS:

Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment.

OUTCOMES:

fever resolution, readmissions, and mortality.

RESULTS:

Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04).

CONCLUSIONS:

Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.