Outcomes in Stable Paediatric Patients With Cancer With Fever and Neutropenia According to Time to Antibiotic...

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Emergency Medicine

Background:

• Febrile neutropenia (FN) is a critical condition in paediatric cancer patients, necessitating prompt management.
• Timely administration of antibiotics is a cornerstone of FN treatment to prevent severe complications.
• The optimal time to antibiotics (TTA) in well-appearing paediatric FN patients remains a subject of investigation.

Purpose of the Study:

• To determine if increased time to antibiotics (TTA) administration impacts clinical outcomes in paediatric cancer patients presenting with febrile neutropenia.
• To identify independent risk factors associated with poor outcomes in this vulnerable patient population.

Main Methods:

• Subanalysis of a prospective, observational study involving 192 episodes in 163 paediatric cancer patients with FN.
• Patients were categorized based on TTA: ≤60 minutes (short TTA) and >60 minutes (long TTA).
• Multivariate analysis was employed to assess risk factors for poor outcomes, including PICU admission, sepsis, organ dysfunction, sequelae, or death.

Main Results:

• No significant difference in poor outcomes was observed between the short TTA (57.3%) and long TTA (42.7%) groups.
• Poor outcomes were associated with higher maximum temperature and elevated C-reactive protein (CRP) levels.
• Multivariate analysis did not identify TTA as an independent risk factor for adverse clinical outcomes.

Conclusions:

• Delayed antibiotic administration in clinically stable paediatric FN patients did not lead to worse outcomes.
• Findings support the potential feasibility of a 'wait-and-observe' approach in select well-appearing paediatric FN cases.
• Further research may refine criteria for selective observation in managing febrile neutropenia.