No abstract available.
Neutropenia*

Background: The treatment of pediatric cancer has advanced dramatically. With the discovery of newer, more potent chemotherapeutic agents, patients are confronted with severe and prolonged degrees of neutropenia, which has inherent consequences. Objective: The study aimed to determine common microbial isolates and predictors of severe outcome of pediatric cancer patients with febrile neutropenia aged 0-18 years old admitted at a tertiary hospital. Methods: This was a cross-sectional study on pediatric cancer patients with febrile neutropenia admitted at the Philippine Children’s Medical Center from March 1,2017 to September 30,2017.The clinical presentations of subjects were noted. Patients were categorized as to the presence or absence of severe outcomes. Common microbial isolates were noted. Predictors of severe outcome were identified using stepwise logistic regression analysis. Results: Out of 105 enrolled patients, 32 developed severe outcomes. The most common isolates were Klebsiella pneumoniae followed by Escherichia coli and Candida species. Univariate analysis showed that acute myelogenous leukemia (p-value: 0.0195), treatment relapse (p-value: 0.0131), ANC on admission 7 days during admission (p-value: 0.0001), non-response to empiric antibiotics (pvalue:0.0001), microbiologically-defined infection (MDI, p-value: 0.0001), fever without a focus p-value:0.001), bloodstream infection (p-value: 0.0192), unknown focus of infection (p-value: 0.0058), and a positive culture (p-value: 0.0001) were related to a severe outcome. None of these predictive variables, however, were statistically significant on multivariate logistic regression analysis. Conclusion K. pneumoniae, E. coli and Candida were the predominant organisms identified in febrile neutropenic cancer patients in our institution. Although AML, treatment relapse, profound neutropenia, fever of >7 days during admission, nonresponse to empiric antibiotics, MDI, fever without a focus, bloodstream infection, unknown focus of infection and a positive culture were related to a severe outcome, multivariate regression analysis did not show these to be significant.
Fever ; Neutropenia

No abstract available.
Drug Therapy* ; Humans ; Neutropenia*

No abstract available.
Drug Therapy* ; Neutropenia*

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatmentresistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed.
Clozapine ; Lithium ; Neutropenia ; Schizophrenia

No abstract available.
Humans ; Neutropenia* ; Sepsis*

Invasive aspergillosis has been reported in patients with profound neutropenia or patients with any form of immunodeficiency. Bone aspergillosis remains a rare. Herein, as we had experienced one case of bone aspergillosis patient treated with voriconazole, we report it with the review of literature.
Aspergillosis* ; Humans ; Neutropenia

Invasive aspergillosis has been reported in patients with profound neutropenia or patients with any form of immunodeficiency. Bone aspergillosis remains a rare. Herein, as we had experienced one case of bone aspergillosis patient treated with voriconazole, we report it with the review of literature.
Aspergillosis* ; Humans ; Neutropenia

Background: Neonatal sepsis complicated with neutropenia increases risk of mortality by 50%. The immature neutrophil production of neonates is often overwhelmed by severe infection. Granulocyte colony stimulating factor (G-CSF), a naturally occurring cytokine used to support neutrophil recovery during chemotherapy, is a possible treatment that can improve outcomes of neonatal sepsis. Objectives: To determine the efficacy of G-CSF in decreasing mortality and morbidity in septic neonates. Methodology: Electronic searches were conducted on online journal databases. Unpublished or ongoing studies ere sought in training institutions accredited by the Philippine Pediatric Society. The investigators included randomized control trials using G-CSF on septic neonates. Results: Twenty-two trials were identified and thirteen were assessed to be eligible for review. The studies had a total of 530 participants, with the largest having 78 subjects. Relative risks (RR), mean differences (MD) and standard mean differences (SMD) with 95% confidence intervals (CI) using the fixed effect model and random effects model were reported in the results. There was a significant decrease in mortality (RR 0.69, 95% CI 0.48 to 0.99) with a greater reduction for preterm neonates, low birth weight neonates and neutropenic neonates. There was no significant reduction in morbidities caused by neonatal sepsis. Conclusions There is moderate quality evidence that suggests that G-CSF as an adjunct treatment for neonatal sepsis significantly decreases mortality with greater benefit to preterm neonates, low birth weight neonates and those with baseline neutropenia. The studies did not show any benefit in reducing sepsis-related morbidity.
Neonatal Sepsis ; Neutropenia

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.
Amikacin* ; Febrile Neutropenia ; Humans ; Mortality