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Treatment of pediatric febrile neutropenia in the era of vancomycin‐resistant microbes
Author(s) -
Kline Ronald M.,
Baorto Elizabeth P.
Publication year - 2005
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20224
Subject(s) - medicine , ceftazidime , febrile neutropenia , antibiotics , neutropenia , vancomycin , vancomycin resistant enterococci , enterococcus , vancomycin resistant enterococcus , intensive care medicine , pediatrics , staphylococcus aureus , chemotherapy , microbiology and biotechnology , bacteria , genetics , pseudomonas aeruginosa , biology
Purpose The increasing frequency of Gm + infections in febrile neutropenic (FN) patients has resulted in increased use of vancomycin (VN). Likely as a result, VN‐resistant Enterococcus (VRE) has become a significant concern in FN patients. We sought to understand how the emergence of VN resistant microbes has changed the antibiotic management of pediatric FN. Methods A questionnaire was distributed by e‐mail to responsible investigators of the Children's Oncology Group. Results One hundred and thirty responses were analyzed. Forty‐four percent initially used monotherapy, with 82% of those using ceftazidime. Twenty‐seven used VN with another agent, generally ceftazidime. After the emergence of VRE and VN‐resistant staphylococcus (VRS), monotherapy increased to 58%. Ceftazidime continued to be most frequently used. There was a 57% reduction in the use of VN with 88% of centers not currently using VN in their initial treatment of FN. Forty‐seven percent of the centers that continue to use VN have VRE, while 90% that have discontinued its use have VRE/VRS. Conclusions Ours is the first study to survey current practices in the treatment of pediatric FN and to document changes in practice patterns due to emerging antibiotic resistance patterns. We demonstrate increased use of monotherapy for FN, and a 57% decrease in the use of VN. Local considerations influence antibiotic choices with a significant difference in VRE prevalence between those centers that continue to use VN as compared to those that have discontinued it. © 2004 Wiley‐Liss, Inc.