Comparison of different timing of empirical antifungal strategy in febrile neutropenic children with acute leukemia
10.3760/cma.j.issn.1673-4912.2022.07.009
- VernacularTitle:急性白血病患儿化疗后中性粒细胞缺乏伴发热不同时机经验性抗真菌治疗策略的效果评价
- Author:
Fan WU
1
;
Yong ZHUANG
;
Yuan ZHANG
;
Xinwei ZHU
;
Xiuli JU
Author Information
1. 山东大学齐鲁医院儿科，济南 250012
- Keywords:
Acute leukemia;
Febrile neutropenia;
Pediatrics;
Invasive fungal disease;
Empirical antifungal therapy
- From:
Chinese Pediatric Emergency Medicine
2022;29(7):525-529
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical value of early and deferred empirical antifungal strategies in febrile neutropenic children with acute leukemia.Methods:A total of 101 cases of febrile neutropenic children with acute leukemia hospitalized in Qilu Hospital of Shandong University from January 2019 to June 2021 were divided into two groups according to different empirical antifungal strategies.There were 41 cases in early group in which antifungal therapy was given within 4 days of fever, and 60 cases in deferred group in which antifungal therapy was not given within 4 days of fever.Outcomes such as time to stable defervescence, positive diagnosis rate of invasive fungal disease, incidence of severe pneumonia, rate of transference to PICU, exposure time and costs of antifungal agents, and infection-related hospitalization days were compared between two groups.Results:There were no significant differences in time to stable defervescence[5 (4, 7) days vs.5 (3, 7) days, P=0.986], positive diagnosis rate of invasive fungal disease[9.8%(4/41) vs.8.3%(5/60), P=1.000], incidence of severe pneumonia[19.5%(8/41) vs.10.0%(6/60), P=0.174], and rate of transference to PICU[2.4%(1/41)vs.0(0/60), P=0.406] between two groups.Exposure time of antifungal agents was longer in early group than that in deferred group[10 (6, 12)days vs.0 (0, 6)days, P<0.001]. Costs of antifungal agents were higher in early group than those in deferred group[0.78(0.51, 0.95)ten thousand yuan vs.0(0, 0.44)ten thousand yuan, P<0.001]. Infection-related hospitalization days were longer in early group than those in deferred group[16 (10, 21) days vs.9(6, 13)days, P<0.001]. Conclusion:For febrile neutropenic children with acute leukemia, clinical effect of early empirical antifungal strategy is not superior to that of deferred empirical antifungal strategy.Pediatricians should make reasonable antifungal decisions according to overall situation of patients.
