Abstract
During 1999 - 2001 authors assessed 50 cases of febrile neutropenia in 45 patients (26 girls, 19 boys) who weretreated at Department of Pediatric Oncology, Prague. The median age was 11 years and 8 months.
They includedpatients whose therapy required to change antibiotic treatment at least twice. All patients had haematologicaltoxicity grade IV (total leukocytes < 1x109/l, neutrophils < 0.5x109/l) after conventional chemotherapy (25x) andmegachemotherapy with stem cell rescue (25x).
Authors assessed number of days with antibiotics, days with feverand grade of infection. First choice of antibiotic treatment included: cefepime, teicoplanin, cefotaxim, isepamicin,amikacin, ampicilin/sulbactam, netilmicin, ciprofloxacin and ceftazidim.
The median number of days with feverwas 3 (2 - 6). During the second choice of treatment they always used piperacilin/tazobactam together withteicoplanin or vancomycin.
The median number of days with fever was 2.27 (1 - 5). Authors had to change theantibiotic treatment for the third choice in 14 patients due to unresolved fever or due to better in vitro resistance.They used meropenem, imipenem, ciprofloxacin, teicoplanin and vancomycin.
The median number of days withfever was 2.57 (1 - 6). The total number of days with fever was 6.24 (3 - 14).
Among these 50 febrile episode theorigin of fever was not microbiologically documented in 29 patients - fever of unknown origin was in 58%.Bacteriemia was proved in 21 patients (42%). The most common pathogen was Staphylococcus epidermidis (12x= 57%).
The ratio between gram-positive and gram-negative bacteriemia was 3.2:1. Febrile infection accordingWHO classification grade II, III was in 21 patients and grade IV in four patients only.
Conclusion: piperacilin/tazobactamtogether with glycopeptide was successful in 36 cases of febrile neutropenia (72%).