İnci ERGÜRHAN İLHAN, Selma ÇAKMAKCI, Meriç KAYMAK CİHAN, Turan BAYHAN, Neriman SARI

Lenfoma ve Solid Tümörlü Çocuklarda Febril Nötropenide Sefaperazon-Sulbaktam Monoterapisinin Etkinliği

Amaç: Febril nötropeninin tedavisinde beta laktam veya bir sefalosporin ile monoterapi, standart haline gelmiştir. Bu çalışmada solid tümörlü ve lenfomalı çocuklarda febril nötropeninin ampirik tedavisi olarak sefoperazon/sulbaktamın (SS) etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Febril nötropenik çocuk hastalara sefaperazon-sulbaktam (80 mg / kg / gün, 8 saatte bir) başlandı. Tedavi yanıtları (a) başarılı, 72. saatte ve 7 günlük SS tedavisinden sonra enfeksiyonun tüm belirti ve semptomlarının tamamen düzelmesi; (b) modifikasyon ile başarılı, viral, parazitik veya mantar enfeksiyonu için tedavi değişikliği veya glikopeptid ilavesi; (c) başarısızlık, yeni veya dirençli bir enfeksiyonun ortaya çıkması, tedaviye dirençli bakteriyemi, karbapenemlere geçme veya aynı spektrumda bir antibiyotik ekleme ihtiyacı olarak tanımlandı. Bulgular: Yüz elli yedi hastaya ait 350 febril nötropeni atağı (K: 73, E: 84, ortanca yaş: 11.8 yıl (0.6-18)) kaydedildi. En sık tanılar sırasıyla osteosarkom (%35), Ewing sarkomu (%30), non-hodgkin lenfoma (%13) ve rabdomyosarkomdu (%9). Ortanca mutlak nötrofil sayısı 60/mm3 (0-800) ve nötropeni süresi 7 gün (3-60)’dı. Ortanca tedavi süresi 7 gündü (3-30). FEN ataklarının 223’ünde (%64) ateşin kaynağı tespit edilemedi, 79’unda (%22) mikrobiyolojik dokümante enfeksiyon (MDE) vardı ve 48’inde (%14) klinik dokümante enfeksiyon mevcuttu (KDE). Başarı oranı %65 (229), modifikasyon ile başarı oranı % 9 (31) ve başarısızlık oranı %26 (90)’dı. Sefoperazon/sulbaktam monoterapisi MDE olan atakların %33’ünde, KDE olan atakların %60’ında başarılı oldu. Ancak SS monoterapisi nedeni bilinmeyen ateşli atakların %82’sinde başarılı oldu. Sonuç: Sefoperazon/sulbaktam, solid tümör ve lenfomalı çocuklarda nötropenik ateşin tedavisinde monoterapi olarak etkili ve güvenlidir.

Anahtar Kelimeler:

Kanser, Sefoperazon, Çocuk, Febril nötropeni, Sulbaktam

Efficacy of Cefoperazone-Sulbactam as Empirical Monotherapy Therapy for Febrile Neutropenia in Children with Solid Tumors and Lymphomas

Objective: Monotherapy with a beta lactam or a cephalosporin has become the standard of care for the treatment of febrile neutropenia (FEN). We aimed to evaluate the efficacy of cefoperazone/sulbactam (CS) as empirical monotherapy for febrile neutropenia in children with solid tumors and lymphomas. Material and Methods: Children with FEN received cefaperazone-sulbactam (80 mg/kg/day, every 8 hours). Treatment responses (a) successful, complete resolution of all signs and symptoms of infection at 72 hours and after 7 days of CS treatment; (b) success with modification, change of therapy for viral, parasitic or fungal infection or addition of glycopeptides; (c) failure was defined as the emergence of a new or resistant infection, treatment-resistant bacteremia, the need to switch to carbapenems. Results: Our study included 157 patients and 350 febrile neutropenia episodes. The most common diagnoses were osteosarcoma (35%), Ewing sarcoma (30%), non-hodgkin lymphoma (13%) and rhabdomyosarcoma (9%), respectively. The origin of fever could not be determined in 223 (64%) of FEN episodes, 79 (22%) had microbiologically documented infection (MDI), and 48 (14%) had clinically documented infection (CDI). The success rate was 65% (229), the success rate with modification was 9% (31) and the failure rate was 26% (90). SC monotherapy was successful in 33% of attacks with MDI and in 60% of attacks with CDI. However, SC monotherapy was successful in 82% of febrile episodes of unknown origin. Conclusion: Cefoperazone/sulbactam is effective and safe in febrile neutropenic children with solid tumors and lymphomas for monotherapy.

Keywords:

Cancer, Cefoperazone, Child, Febrile neutropenia, Sulbactam,

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