Outcome of Infants Born to Women with Chronic Hepatitis B: A Local Risk-Based Strategy in a Low Prevalence Country.

BACKGROUND: Chronic hepatitis-B virus (HBV) infection due to mother-to-child transmission (MTCT) during the perinatal period is an important global health concern. Chile is a low-prevalence country with an increasing migratory inflow from Latin- American countries, with intermediate to high endemic rates of HBV infection, and until 2021, there is no universal maternal screening. This study aimed to evaluate infant outcomes using a risk-based strategy of maternal screening to prevent MTCT of hepatitis B virus (HBV) in a low-prevalence country. METHODS: This prospective study included infants born to HBsAg-positive women detected using a local risk-based strategy. The exposed infants received immunoprophylaxis (IP) and follow-up to evaluate their clinical outcomes and immune responses through post-serological vaccine testing (PSVT) after completing the three- dose schedule of the HBV vaccine. RESULTS: A total of 99 HBsAg-positive mothers were detected. Seventy-six (82%) infants completed the follow-up and had PSVT between 9 and 12 months of age. 55.2% female, the median gestational age was 39 weeks (25-41) and the median birth weight was 3,130g (816-4,400 g). All patients received IP with recombinant HBV vaccine plus hepatitis-B virus immunoglobulin (HBIG) and three doses of the HBV vaccine. There were no cases of HBV infection, and 96% (72) responded to immunization with HBsAg antibodies (anti-HBsAg) >10 UI/ml, with a median level of 799 IU/ml. CONCLUSIONS: A high-risk strategy can be implemented in countries with non-universal screening for VHB. Timely IP plus high-uptake VHB vaccination in infants born to HBsAg-positive mothers was associated with a high immunogenic response and absence of MTCT.

Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease.

BACKGROUND: Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD). The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children. METHODS: Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children's tertiary health care centers in Santiago, Chile, between 2010 and 2018. Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed. RESULTS: In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB. The median age was 9 months, 67% were male and 18.7% had any comorbidity. A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea. Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9%. Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively. We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support. Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency. CONCLUSION: Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD.

Clinical Outcome in Children With Cancer With Two or More Microorganisms Isolated From Blood Cultures During Episodes of Fever and Neutropenia.

BACKGROUND: Bacterial bloodstream infections are a major cause of morbidity and mortality in children with cancer and episodes of fever and neutropenia (FN). The aim of this study was to evaluate the clinical outcome in children with cancer with 2 or more microorganisms isolated from blood cultures during their episodes of FN. METHODS: Between 2016 and 2021, children presenting with high-risk FN, admitted to any of the 6 participating hospitals in Santiago, Chile, were included in this study if they have positive blood cultures. We compared the clinical outcome of children with 2 or more microorganisms versus those with single agent isolation. RESULTS: A total of 1074 episodes of high-risk FN were enrolled in the study period, of which 27% (298) had positive blood cultures and 3% (32) had 2 or more microorganisms isolated from blood cultures. The most frequent identified agents were Viridans group streptococci and Escherichia coli in 20%, followed by Coagulase negative staphylococci in 14%. Children with 2 or more microorganisms presented more days of fever (7 vs. 4 days, P = 0.02), needed longer courses of antimicrobial therapy (16 vs. 14 days, P = 0.04) and had higher mortality at day 30 (13% vs. 1%, P = 0.003). CONCLUSIONS: Children with cancer and FN with 2 or more microorganisms isolated from blood cultures had a worse clinical outcome than children with single agent isolation.

Caracterización clínica y microbiológica de episodios de bacteriemia por Streptococcus grupo viridans en niños con cáncer y neutropenia febril de alto riesgo / Clinical characteristics and microbiological profile of viridans group streptococci bacteremia in children with cancer and high-risk febrile neutropenia

Resumen Introducción: Streptococcus grupo viridans (SGV) ha adquirido relevancia como microorganismo causante de neutropenia febril, asociándose a morbilidad significativa. Objetivo: Caracterizar episodios de bacteriemia causados por SGV en niños con cáncer que desarrollaron neutropenia febril de alto riesgo (NFAR) desde abril de 2004 a junio de 2018 en seis hospitales pediátricos de Santiago, Chile. Pacientes y Métodos: Análisis retrospectivo de bases de datos de cuatro proyectos FONDECYT sucesivos, prospectivos y multicéntricos, registrando características clínicas y de laboratorio de los pacientes, además de patrón de resistencia antimicrobiana de las cepas aisladas. Resultados: Se registraron 95 episodios de bacteriemia asociada a SGV en 91 niños con NFAR. Destacan: leucemia mieloide aguda como enfermedad de base, neutropenia profunda, hospitalización prolongada (15 días), uso extendido de antimicrobianos (14 días), uso de citarabina en esquemas de quimioterapia (86% episodios). Las manifestaciones clínicas más frecuentes fueron respiratoria y gastrointestinal, asociándose en 26% a síndrome de shock por Streptococcus grupo viridans. Hubo elevada resistencia a β lactámicos, sin cepas no susceptibles a vancomicina. Discusión: SGV es un patógeno relevante en niños con cáncer, fiebre y neutropenia en nuestro medio, asociado a casos de sepsis. La resistencia a β lactámicos es un aspecto que requiere vigilancia epidemiológica estricta en esta población.

Abstract Background: Viridans group streptococci (VGS) has acquired relevance as a microorganism causing febrile neutropenia, associated with significant morbidity. Aim: To characterize episodes of bacteremia caused by VGS in children with cancer who developed high-risk febrile neutropenia (HRFN) during the period from April 2004 to June 2018 in six pediatric hospitals of Santiago, Chile. Method: Database analysis of 4 successive, prospective and multicentric studies recording clinical and laboratory characteristics of patients, as well as antimicrobial susceptibility pattern of isolated strains. Results: 95 episodes of VGS bacteremia in 91 children with HRFN were analyzed. It emphasizes acute myeloid leukemia as cancer type, deep neutropenia, prolonged hospitalization (15 days), with extended use of antimicrobials (14 days) and use of cytarabine in chemotherapy schemes (86% episodes). The most frequent clinical manifestations were respiratory and gastrointestinal, associating up to 26% viridans group shock syndrome. There was high resistance to β lactams. As expected, there were not non-susceptible strains to vancomycin. Discussion: VGS is a relevant microorganism in children with cancer, fever and neutropenia, with a high percentage of sepsis. Resistance to β lactams is an issue that requires strict epidemiological surveillance in this population.

[Clinical characteristics and microbiological profile of viridans group streptococci bacteremia in children with cancer and high-risk febrile neutropenia]. / Caracterización clínica y microbiológica de episodios de bacteriemia por Streptococcus grupo viridans en niños con cáncer y neutropenia febril de alto riesgo.

BACKGROUND: Viridans group streptococci (VGS) has acquired relevance as a microorganism causing febrile neutropenia, associated with significant morbidity. AIM: To characterize episodes of bacteremia caused by VGS in children with cancer who developed high-risk febrile neutropenia (HRFN) during the period from April 2004 to June 2018 in six pediatric hospitals of Santiago, Chile. METHOD: Database analysis of 4 successive, prospective and multicentric studies recording clinical and laboratory characteristics of patients, as well as antimicrobial susceptibility pattern of isolated strains. RESULTS: 95 episodes of VGS bacteremia in 91 children with HRFN were analyzed. It emphasizes acute myeloid leukemia as cancer type, deep neutropenia, prolonged hospitalization (15 days), with extended use of antimicrobials (14 days) and use of cytarabine in chemotherapy schemes (86% episodes). The most frequent clinical manifestations were respiratory and gastrointestinal, associating up to 26% viridans group shock syndrome. There was high resistance to ß lactams. As expected, there were not non-susceptible strains to vancomycin. DISCUSSION: VGS is a relevant microorganism in children with cancer, fever and neutropenia, with a high percentage of sepsis. Resistance to ß lactams is an issue that requires strict epidemiological surveillance in this population.

[Support of the laboratory of microbiology and pathological anatomy in the diagnosis and management of infections in cancer patients and transplantation of hematopoietic stem cell transplant receptors]. / Parte III. Apoyo del laboratorio de microbiología y anatomía patológica en el diagnóstico y manejo de infecciones en el paciente con cáncer y trasplante de precursores hematopoyéticos.

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.

Parte III. Apoyo del laboratorio de microbiología y anatomía patológica en el diagnóstico y manejo de infecciones en el paciente con cáncer y trasplante de precursores hematopoyéticos / Support of the laboratory of microbiology and pathological anatomy in the diagnosis and management of infections in cancer patients and transplantation of hematopoietic stem cell transplant receptors

Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.

Resultado de un modelo de gestión de vacunas especiales / Result of a model of management of special vaccines

Resumen Introducción: Los pacientes pediátricos con recomendaciones especiales de vacunación son una po blación creciente. El Ministerio de Salud de Chile posee un programa de vacunación especial para estos casos, al cual nuestro hospital gestiona solicitudes de vacunas a través de un flujograma esta blecido. Objetivo: Describir los resultados del modelo de gestión de vacunas especiales, marzo de 2015 a septiembre de 2016, y caracterizar a la población beneficiada por este programa. Pacientes y Método: Estudio observacional, descriptivo. Incluye a la población de pacientes crónicos atendidos en el Hospital Dr. Exequiel González Cortés (HEGC) con vacunas solicitadas al programa ministerial de vacunas especiales, período marzo 2015 a septiembre 2016. La información se obtuvo de las bases de datos de los registros de solicitudes y monitorización de los esquemas especiales de vacunas del Programa Nacional de Inmunizaciones (PNI). Los pacientes se clasificaron en crónicos ambulato rios, ambulatorios y hospitalizados. Para la caracterización clínica y demográfica se describieron las variables de edad, sexo, previsión de salud, especialidad médica que solicitó la vacuna, cronicidad y vacunas administradas. Para medir los resultados del modelo de gestión de vacunas especiales se utilizaron indicadores: Autorización de esquema de vacunación por el PNI, Esquemas de vacunación completados, Tiempo de repuesta del PNI y Oportunidad de vacunación. Resultados: Se gestionaron un total de 367 esquemas de vacunas a 215 pacientes, administrándose en el período un total de 405 vacunas. Las especialidades que más solicitaron fueron infectología (39,1%), inmuno-reumatología (24,2%) y broncopulmonar (20%). El Programa Nacional de Inmunizaciones autorizó el 97,8% de los esquemas solicitados (n = 359), el tiempo de respuesta desde la solicitud hasta la respuesta del Programa Nacional de Inmunizaciones tuvo una mediana de 15 días (rango 0-174 días), la oportu nidad de vacunación tuvo una mediana de 41 días (rango 0-287 días) y el total de esquemas com pletados al momento de tabular los resultados fue de 52,8%. Conclusiones: Las vacunas son una de las principales políticas de equidad en salud pública y en Chile existe un flujograma para solicitud de vacunas especiales, que requiere de un trabajo multidisciplinario para otorgarle cobertura a esta población infantil vulnerable.

Abstract Introduction: Special vaccines recommendation patients are a growing population. The Ministry of Health has developed a special vaccination program for these cases, through which our hospital manages vaccine forms by an established flowchart. Objective: To describe the special vaccines model of management results in the period between March 2015 and September 2016, and the clinical and demographics characterization of the pediatric population benefited with this program in Dr. Exe-quiel González Cortés Children's Hospital. Patients and Methods: We performed a descriptive ob servational study, which covers the chronically ill patient's population who received special vaccines during the period between March 2015 to September 2016. Results: A total of 367 vaccine schemes were administered to 215 patients, with a total of 405 vaccines administered during the period. The medical specialties that most requested vaccines were infectology (39.1%), immune-rheumatology (24.2%) and bronchopulmonary specialists (20%). The National Immunization Program authorized 97.8% of the requested schemes (n = 359), the response time had a median of 15 days (range 0-174 days), the vaccination opportunity had a median of 41 days (range 0-287 days) and the total of sche mes completed at the time of tabulating the results was 52.8%. Conclusions: Vaccines are one of the main public health equity policies and Chile has special vaccines request flowchart a flow chart, which requires a multidisciplinary work to provide coverage to this vulnerable child population.

[Result of a model of management of special vaccines]. / Resultado de un modelo de gestión de vacunas especiales.

INTRODUCTION: Special vaccines recommendation patients are a growing population. The Ministry of Health has developed a special vaccination program for these cases, through which our hospital manages vaccine forms by an established flowchart. OBJECTIVE: To describe the special vaccines model of management results in the period between March 2015 and September 2016, and the clinical and demographics characterization of the pediatric population benefited with this program in Dr. Exe-quiel González Cortés Children's Hospital. PATIENTS AND METHODS: We performed a descriptive ob servational study, which covers the chronically ill patient's population who received special vaccines during the period between March 2015 to September 2016. RESULTS: A total of 367 vaccine schemes were administered to 215 patients, with a total of 405 vaccines administered during the period. The medical specialties that most requested vaccines were infectology (39.1%), immune-rheumatology (24.2%) and bronchopulmonary specialists (20%). The National Immunization Program authorized 97.8% of the requested schemes (n = 359), the response time had a median of 15 days (range 0-174 days), the vaccination opportunity had a median of 41 days (range 0-287 days) and the total of sche mes completed at the time of tabulating the results was 52.8%. CONCLUSIONS: Vaccines are one of the main public health equity policies and Chile has special vaccines request flowchart a flow chart, which requires a multidisciplinary work to provide coverage to this vulnerable child population.

Profilaxis de toxoplasmosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).

Toxoplasmosis es una zoonosis ampliamente distribuida, producida por el parásito T. gondii. En Chile la seroprevalencia se ha estimado entre 20-37% en la población general. Se han deinido grupos de riesgo de adquirir o reactivar la infección por T. gondii en pacientes sometidos a TOS y a TPH: trasplante cardíaco o de corazón-pulmón con D (+) y R (-); TPH alogénico con R (+); TPH con células de cordón; EICH activa; antecedentes de toxoplasmosis clínica previa y uso de corticoesteroides por tiempo prolongado o en altas dosis. De manera universal son importantes el lavado de manos e higiene en manipulación de alimentos y el seguimiento periódico post-trasplante con RPC desde los 15 días, una vez por semana, durante seis meses. Todos los pacientes con TOS y TPH, independiente de su riesgo, deben recibir proilaxis universal con cotrimoxazol y no requieren otra proilaxis especíica contra T. gondii ( A2 ). Es particularmente importante que en los pacientes de alto riesgo que no puedan recibir cotrimoxazol, se establezca proilaxis alternativa especíica contra T. gondii (B3).

[Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation]. / Profilaxis de toxoplasmosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos.

Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).

Predictors of severe sepsis not clinically apparent during the first twenty-four hours of hospitalization in children with cancer, neutropenia, and fever: a prospective, multicenter trial.

BACKGROUND: Severe sepsis is not clinically apparent during the first 24 hours of hospitalization in most children with cancer and febrile neutropenia (FN), delaying targeted interventions that could impact mortality. The aim of this study was to prospectively evaluate biomarkers obtained within 24 hours of hospitalization as predictors of severe sepsis before it becomes clinically evident. METHODS: Children with cancer, admitted with FN at high risk for an invasive bacterial infection in 6 public hospitals in Santiago, Chile, were monitored throughout their clinical course for occurrence of severe sepsis. Clinical, demographic and 6 biomarkers [eg, blood urea nitrogen, serum glucose, lactic dehydrogenase, serum C-reactive protein (CRP), interleukin (IL)-8, and procalcitonin] were obtained at the time of admission and after 24 hours. Biomarkers independently associated with severe sepsis diagnosed after the first 24 hours of hospitalization were identified by logistic regression analysis. RESULTS: A total of 601 high risk FN episodes were enrolled between June 2004 and October 2006; 151 (25%) developed severe sepsis of which 116 (77%) were not clinically apparent during the first 24 hours of hospitalization. Risk factors for severe sepsis were age > or =12 years [odds ratio (OR): 3.85; 95% confidence interval (CI): 2.41-6.15], admission CRP > or =90 mg/L (OR: 2.03; 95% CI: 1.32-3.14), admission IL-8 > or =200 pg/mL (OR: 2.39; 95% CI: 1.51-3.78), 24-hour CRP > or =100 mg/L (OR: 3.06; 95% CI: 1.94-4.85), and 24-hour IL-8 > or =300 pg/mL (OR: 3.13; 95% CI 1.92-5.08). CONCLUSIONS: Age > or =12 years and admission or 24-hour values of CRP > or =90/100 mg/L and IL-8 > or =200/300 pg/mL are predictors of sepsis not clinically apparent during the first 24 hours of hospitalization.

Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode.

BACKGROUND: Early identification of children with cancer at risk for death during a febrile neutropenic (FN) episode may increase their possibility for survival. Our aim was to identify at the time of admission, clinical and laboratory variables differing significantly among children who survived or died during a FN episode. METHODS: In a prospective, multicenter study, children admitted with a high-risk FN episode were uniformly evaluated at enrollment and managed according to a national consensus protocol. Medical charts of children who died were evaluated to determine whether the death could be associated with an infection. Admission clinical and laboratory variables significantly associated with death were identified. RESULTS: A total of 393 (70%) of 561 FN episodes evaluated from June 2004 to December 2005 were classified as high risk for invasive bacterial infection, of which 14 (3.6%) resulted in an infectious-related death. Deaths occurred from 2 to 27 days after admission, and most dying children were admitted with relapse of acute lymphocytic leukemia (36%), hypotension (71%), and a diagnosis of sepsis (79%), compared with surviving children (16%, 20%, and 5% respectively, P < 0.001). Children who died were admitted with lower absolute neutrophil count (P < 0.001) and absolute monocytes count levels (P = 0.008), higher blood urinary nitrogen (P = 0.03) and C-reactive protein values (P < 0.001), and had more positive cultures (79% versus 32%, P = 0.008). CONCLUSIONS: We identified early clinical and laboratory findings significantly associated with death occurring at a later stage. Routine evaluation of these variables may prove to be useful in the early identification of children with a high-risk FN episode at risk for death.

[Consensus: Rational approach towards the patient with cancer, fever and neutropenia]. / Consenso: Manejo racional del paciente con cáncer, neutropenia y fiebre.

The severity and duration of post chemotherapy neutropenia were recognized during the 1960s as main predisposing factors for infections in cancer patients. At the beginning of the 70's a standard management approach for all febrile neutropenia (FN) episodes was proposed, based on hospitalization and intravenous empirical broad spectrum antibiotic therapy. Widespread use of this approach resulted in a significant reduction in mortality attributable to bacterial infections. During the last 10 to 15 years, reappraisal of this standard approach has been done by several research groups who question the benefit of treating all FN patients similarly without taking in to consideration differences in severity of the FN episodes. This reappraisal has led during the 1990s to the development of the concept of high and low risk FN episodes that has been the base for the adoption of selective therapies based on the risk categorization of the individual patient. The Chilean Infectious Diseases Society called upon two government National Programs responsible for the appropriate distribution of chemotherapeutic drugs to all pediatric and adults cancer patients within the public health system, and upon the Chilean Hematology Society for the development of a Consensus on Diagnosis, Treatment and Prevention of Infections during FN Episodes in Cancer patients. The need for this Consensus is based on two main aspects: the new approaches proposed during the past year for management of these episodes, and the increasing population of cancer patients receiving improved chemotherapeutic agents that has increased there survival possibilities as well as there possibility to suffer a FN episode. The topics discussed in this document are based on an updated systematic and analytic review of the medical literature including epidemiology, laboratory diagnostics, risk categorization, treatment and prophylaxis. National data was included when available in order to provide the healthcare personnel that take care of these patients with best evidence based recommendations adjusted to the Chilean reality.

Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection.

PURPOSE: To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI). PATIENTS AND METHODS: Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and cost were determined for each episode and compared between both groups using predefined definitions and questionnaires. RESULTS: A total of 161 (41%) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk, of which 149 were randomly assigned to ambulatory (n = 78) or hospital-based (n = 71) treatment. In both groups, mean age (ambulatory management, 55 months; hospital-based management, 66 months), sex, and type of cancer were similar. Outcome was favorable in 74 (95%) of 78 ambulatory-treated children and 67 (94%) of 71 hospital-treated children (P = NS). Mean cost of an episode was US 638 dollars (95% CI, 572 dollars to 703 dollars) and US 903 dollars (95% CI, 781 dollars to 1,025 dollars) for the ambulatory and hospital-based groups, respectively (P =.003). CONCLUSION: For children with febrile neutropenia at low risk for IBI, ambulatory management is safe and significantly cost saving compared with standard hospitalized therapy.