Journal of paediatrics and child health · 2025
Outcomes in Stable Paediatric Patients With Cancer With Fever and Neutropenia According to Time to Antibiotic Administration: A Prospective Observational Study.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Vergara Muñoz Beatriz, Sancosmed Ron Monica, Suárez-Bustamante Huélamo María, Lera Carballo Esther, Rodríguez Jiménez Ana, Rodrigo Rocio, Alonso-Cadenas José Antonio
Аннотация
AIM: To evaluate whether an increase in the time to antibiotics (TTA) administration in the paediatric emergency department worsens the clinical outcomes of well-appearing paediatric cancer patients with febrile neutropenia (FN).
METHODS: We performed a subanalysis of a prospective, observational study conducted in two hospitals between November 2019 and October 2021. Multivariate analysis was performed to identify independent risk factors for poor outcomes, defined as admission to the paediatric intensive care unit, sepsis or septic shock, acute organ dysfunction, long-term sequelae, or death.
RESULTS: We included 192 episodes in 163 patients. A total of 110 episodes (57.3%) had a TTA ≤ 60 min (short TTA) and 82 (42.7%) had a TTA > 60 min (long TTA). Baseline characteristics were similar in both groups, except for previous FN episodes, which were more frequent in the short TTA group (64.5% vs. 8.5%, p < 0.001). Twelve episodes (6.3%) resulted in a poor outcome, although no deaths were reported. Poor outcomes were more common in patients with higher maximum temperature (odds ratio [OR]: 2.7; 95% CI: 1.1-6.6), and elevated CRP (OR: 1.01; 95% CI 1.003-1.02). In the multivariate analysis, no variable-including TTA-was identified as an independent risk factor for poor outcome.
CONCLUSIONS: Delayed antibiotic administration in clinically stable paediatric FN patients did not worsen outcomes, supporting the potential feasibility of a 'wait-and-observe focus' approach.
METHODS: We performed a subanalysis of a prospective, observational study conducted in two hospitals between November 2019 and October 2021. Multivariate analysis was performed to identify independent risk factors for poor outcomes, defined as admission to the paediatric intensive care unit, sepsis or septic shock, acute organ dysfunction, long-term sequelae, or death.
RESULTS: We included 192 episodes in 163 patients. A total of 110 episodes (57.3%) had a TTA ≤ 60 min (short TTA) and 82 (42.7%) had a TTA > 60 min (long TTA). Baseline characteristics were similar in both groups, except for previous FN episodes, which were more frequent in the short TTA group (64.5% vs. 8.5%, p < 0.001). Twelve episodes (6.3%) resulted in a poor outcome, although no deaths were reported. Poor outcomes were more common in patients with higher maximum temperature (odds ratio [OR]: 2.7; 95% CI: 1.1-6.6), and elevated CRP (OR: 1.01; 95% CI 1.003-1.02). In the multivariate analysis, no variable-including TTA-was identified as an independent risk factor for poor outcome.
CONCLUSIONS: Delayed antibiotic administration in clinically stable paediatric FN patients did not worsen outcomes, supporting the potential feasibility of a 'wait-and-observe focus' approach.