Resumen
Introducción
Los pacientes oncológicos con neutropenia febril no constituyen un grupo de riesgo homogéneo. Algunos investigadores han propuesto que los pacientes oncológicos con neutropenia febril que reúnen criterios de bajo riesgo de bacteriemia pueden ser tributarios de tratamiento antibiótico domiciliario. Los objetivos son: conocer la incidencia de bacteriemia en nuestra población de pacientes oncológicos febriles y determinar la existencia de criterios de riesgo de bacteriemia de forma que pueda considerarse el manejo extrahospitalario en pacientes seleccionados.
Material y métodos
Se efectúa una revisión de las historias clínicas de los enfermos con patología hematooncológica ingresados en nuestro centro con fiebre y neutropenia, durante el año 2002.
Resultados
Se describen un total de 62 episodios febriles en 30 pacientes. En 24 casos los pacientes presentaban un tumor de origen hematológico y 38 un tumor sólido. Se definen como criterios de alto riesgo; ser menor de 1 año, escasa respuesta medular, quimioterapia en los 10 días previos, neutropenia de rápida evolución, leucemia en recidiva, tumor sólido no controlado y enfermedad cardíaca o renal asociada. En función del número de criterios de riesgo de cada paciente, se observa que los pacientes que tienen dos o menos criterios de riesgo tienen una incidencia de bacteriemia del 6,7% (1/16), mientras que los que tienen tres o más tienen una incidencia de bacteriemia del 32,6% (15/46) con p<0,05.
Conclusiones
La incidencia de bacteriemia en nuestra seríe es algo mayor que la bibliografía con predominio de bacilos grammegativos; la probabilidad de presentar bacteriemia se incrementa de forma proporcional a los criterios de riesgo individuales, y la existencia de subgrupos de pacientes de menor riesgo posibilita que puedan definirse unos criterios de selección para el manejo extrahospitalario de estos pacientes.
Abstract
Introduction
Cancer patients with febrile neutropenia are not a homogeneous group with respect to risk of bacterial infections. Some authors have proposed that febrile cancer patients with low risk factors of bacteraemia could be managed at home with domiciliary antibiotic treatment. The objectives are: to determine the incidence of bacteraemia in our cancer patients who have febrile neutropenia; and to identify the low-risk factors so that the patients can be managed at home using domiciliary antibiotic treatment.
Material and methods
Clinical review of paediatric haemato-oncology disease admitted to our hospital in 2002 suffering from febrile neutropenia.
Results
We describe a total of 62 episodes of febrile neutropenia in 30 patients; 24 episodes in haematology patients and 38 episodes in oncology patients. High-risk criteria are age <1 year, poor bone-marrow recovery, chemotherapy within 10 days of the episode, rapid fast neutropenia, leukaemia in relapse, uncontrolled solid cancer, and cardiac or nephrology disease. Based on the number of risk-factors, patients with two or less risk-factors have an incidence of bacteraemia of 6.7% (1/16) and patients with three or more risk factors have an incidence of bacteraemia of 32.6% (15/46); p<0.05.
Conclusions
Incidence of bacteraemia is similar to the reviewed literature; probability of bacteraemia increases with the number of individual risk factors, and patients with low risk of bacteraemia could be managed on an outpatient basis using domiciliary antibiotic treatment.
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Peralta, S.G., Salzman, T.C., García, J.J.G. et al. Criterios de riesgo de bacteriemia en el paciente oncológico neutropénico febril pediátrico. Clin Transl Oncol 7, 165–168 (2005). https://doi.org/10.1007/BF02708754
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DOI: https://doi.org/10.1007/BF02708754