Metin DEMİRKAYA, Taner ÖZGÜR, Betül SEVİNİR, Mustafa HACIMUSTAFAOĞLU, Solmaz ÇELEBİ

Lenfoma ve solid tümörlü çocuklarda febril nötropeni: Tek merkez deneyimi

Amaç: Merkezimizde tedavi edilen kanserli çocuklardaki febril nötropeni ataklarının değerlendirilmesidir. Gereç ve Yöntem: Ocak 2000-Aralık 2005 tarihleri arasında febril nötropeni tanısı ile hastaneye yatırılan 57 lenfoma ve solid tümörlü hastada 206 febril nötropeni atağı geriye dönük olarak incelendi. Bulgular: Febril nötropeni atağı sırasında bakılan ortalama mutlak nötrofil sayısı (MNS) 296±342/mm3, mutlak lenfosit sayısı (MLS) 518±896/mm3, mutlak monosit sayısı (MMS) 144±262/mm3, C-reactive protein (CRP) 7,63±7,06 mg/dL, ateş 38,5±0,2°C olarak bulundu. Atakların %57,3’ünde enfeksiyon odağı yoktu. Saptanan odaklar arasında en sık farenjit %14 ve mukozit %12,1 görüldü. Atakların %87,8’inde üçüncü kuşak sefalosporin ve aminoglikozid birlikte uygulandı. Kan kültürlerinin %14,6’sında üreme görüldü. Üreyen etkenler arasında gram negatif bakteriyemi oranı yüksekti (%60). En sık üreyen etkenler E.coli (%16,7), Enterobacter cloaca (%13,3), S.epidermidis (%13,3) olarak bulundu. Ampirik tedavi başarı oranı %67,5 saptandı. Tanı anındaki enfeksiyon odağı, MNS, MMS, CRP ile bakteriyemi arasında ilişki saptanmadı. Atak sırasında mukozit varlığının yatış süresini anlamlı olarak uzattığı görüldü. Tedavi rejimleri arasında tedavi başarısı, bakteriyemi ve yatış süresi açısından anlamlı fark saptanmadı. Nötropeni süresinin nöroblastom ve beyin tümörleri grubunda daha uzun olduğu saptandı. Ölüm oranı %1,45 idi. Çıkarımlar: Enfeksiyon etkenlerinin üretilme oranı düşük olan çalışmamızda gram negatif bakteriyemi oranı daha yüksekti. Gram pozitif bakteriyemi oranının düşük olmasının nedeninin hiçbir hastada santral venöz kateter kullanılmamasına bağlı olduğu düşünüldü. Körlemesine tedavide sefalosporin ve aminoglikozidin birlikte kullanılması ile başarı oranı yüksek ve ölüm oranı düşüktü.

Febrile neutropenia in children with lymphoma and solid tumors: One center experience

Aim: The objective of this study is to evaluate the febrile neutropenia attacks in the children who have been treated for cancer in our center. Material and Method: Between January 2000 and December 2005, 57 patients with lymphoma and solid organ tumors who, had a total of 206 attacks of febril neutropenia were evaluated retrospectively. Results: The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296±342/mm3, 518±896/mm3, 144±262/mm3, respectively. The mean C-reactive protein (CRP) level was 7.63±7.06 mg/dL, Hb level was 8.67±1.74 g/dL and fever was 38.5±0.2°C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions: The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination.

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