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Home intravenous antibiotic treatment for febrile episodes in immune-compromised pediatric patients
E Shemesh1, I Yaniv, M Drucker
1National Center for Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Tel Aviv, Israel.
Insights
Home intravenous antibiotic treatment (HIAT) is feasible and safe for low-risk pediatric patients with febrile episodes. Most patients and families were satisfied, though Pseudomonas infections may require hospitalization.
Area of Science:
- Pediatric Hematology-Oncology
- Infectious Diseases
- Pharmacology
Background:
- Febrile episodes in immunocompromised children pose a risk for serious infection.
- Low-risk pediatric patients with neutropenia or splenectomy may be candidates for outpatient management.
- Home intravenous antibiotic treatment (HIAT) offers a potential alternative to hospitalization.
Purpose of the Study:
- To evaluate the feasibility, safety, and patient acceptance of home intravenous antibiotic treatment (HIAT) for febrile episodes in low-risk pediatric patients with compromised immune systems.
- To identify factors associated with treatment unresponsiveness and adverse events during HIAT.
Main Methods:
- A retrospective study of 30 hematology-oncology patients discharged on HIAT for febrile episodes between January 1993 and January 1995.
- Patients were followed for at least 3 weeks post-recovery, with data collected via retrospective questioning regarding adverse effects and satisfaction.
- Hospitalization during the study period was considered treatment failure, and causes were analyzed.
Main Results:
- Out of 60 febrile episodes, 13 (22%) required hospitalization; 8 of 42 (19%) episodes of fever and neutropenia led to hospitalization.
- Pseudomonas species infections were linked to the highest unresponsiveness rate (88%).
- Two central venous catheter infections occurred in 640 days of therapy; no other complications or infection-related morbidity were observed. Patients and families reported high satisfaction.
Conclusions:
- Immediate discharge on HIAT for selected low-risk pediatric immunocompromised patients with febrile episodes is feasible, safe, and well-accepted.
- Hospitalization should be considered for patients with Pseudomonas infections.
- Further confirmation through prospective, randomized trials is recommended before widespread implementation.
Abstract:
The purpose of this work was to assess the feasibility of home intravenous antibiotic treatment (HIAT) for febrile episodes in immune-compromised (neutropenic, splenectomized), low-risk pediatric patients. Thirty hematology-oncology patients who presented to our emergency room from January 1993 to January 1995 and who suffered from a febrile episode and were considered at low risk for septic complications were immediately discharged on HIAT. Patients were followed for at least 3 weeks after recovery. Patients and parents were retrospectively questioned about adverse effects and about their degree of satisfaction with home treatment. Patients who required hospitalization during this period were considered unresponsive to HIAT and were analyzed for causes and adverse effects. Thirteen out of 60 (22%) febrile episodes, or eight out of 42 (19%) episodes of fever and neutropenia eventually led to hospitalization. Pseudomonas species infections were associated with the highest rate of unresponsiveness (88%). A central venous catheter infection developed in two cases following HIAT (two cases out of 640 days of therapy). No other complications were identified. No infection-related morbidity was observed. Patients and parents were highly satisfied with HIAT and wanted to use it again, if necessary. Immediate discharge on HIAT for low-risk pediatric immune-compromised patients suffering from a febrile episode is feasible, safe, and well accepted by patients and families. Patients who are found to have Pseudomonas infections should probably be hospitalized. Our results are preliminary and must be confirmed by a prospective, randomized trial before definite recommendations can be made.