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Asymptomatic C‐reactive protein elevation in neutropenic children
Author(s) -
Sugiura Shiro,
Ito Tsuyoshi,
Koyama Norihisa,
Sasaki Noriko,
Ikai Hiroshi,
Imanaka Yuichi
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13077
Subject(s) - medicine , neutropenia , asymptomatic , antibiotics , incidence (geometry) , febrile neutropenia , bacteremia , acute leukemia , medical record , asymptomatic carrier , pediatrics , leukemia , gastroenterology , chemotherapy , physics , optics , microbiology and biotechnology , biology
Background Febrile neutropenia ( FN ) can be a life‐threatening complication in children with malignancies. There is no standardized preventive treatment for childhood FN , and information on C‐reactive protein ( CRP ) elevation in afebrile patients with neutropenia ( CEAN ) is limited. The aim of this study was therefore to identify the association between CEAN and FN onset, and evaluate the efficacy of broad‐spectrum antibiotics for FN prophylaxis. Methods We retrospectively reviewed the medical records of 22 consecutive pediatric patients with hematologic malignancies (acute myeloid leukemia, n = 2; acute lymphoid leukemia, n = 20) admitted to the present institution between 2006 and 2011. CEAN was defined as CRP elevation ≥0.05 mg/ dL between the two most recent blood tests with no fever. We identified CEAN before FN onset, and assessed the efficacy of broad‐spectrum antibiotics for FN prevention in CEAN . FN incidence within 48 h after CEAN detection was compared between prophylactic and non‐prophylactic episodes. Results CEAN was observed before FN onset in 20 (55.6%), of 36 FN episodes. Among the 95 analyzed CEAN episodes, broad‐spectrum antibiotics had been used for 30 episodes (prophylactic episodes), whereas these antibiotics had not been used in 60 episodes (non‐prophylactic episodes). Prophylactic episodes had a significantly lower FN incidence than non‐prophylactic episodes (6.7% and 31%, respectively, P < 0.01) within 48 h after CEAN detection. Bacteremia was observed in three non‐prophylactic episodes. Conclusion Patients with CEAN are at higher risk of FN , and physicians may consider the use of broad‐spectrum antibiotics to prevent FN development.