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Outcome and Risk Factors of Febrile Episodes Treated with Broad Spectrum Antibiotics and Polyclonal IgM–Enriched Immunoglobulin in Pediatric Oncology Hematology Patients: A Retrospective Study.

Authors :
Abram, Nicoletta
Baretta, Valentina
Mercolini, Federico
De Bortoli, Massimiliano
Chinello, Matteo
Balter, Rita
Bonetti, Elisa
Zaccaron, Ada
Vitale, Virginia
Caddeo, Giulia
Mauro, Margherita
Battisti, Laura
Tridello, Gloria
Cesaro, Simone
Source :
Journal of Pediatric Infectious Diseases. Jan2022, Vol. 17 Issue 1, p40-47. 8p.
Publication Year :
2022

Abstract

Objective  Preparations with high-titer immunoglobulin-M (HT-IgM) have been used to treat neonatal and adult sepsis as adjuvant to antibiotics. Limited data are available of this use in pediatric oncohematological patients. We retrospectively assessed the characteristics and outcome of febrile episodes treated with broad-spectrum antibiotics and HT-IgM. Methods  This study included febrile episodes diagnosed after chemotherapy or hematopoietic stem cell transplantation (HSCT) treated with antibiotics and HT-IgM. Study period was from January 2011 to March 2019. Results  Seventy febrile episodes in 63 patients were eligible. In 40% of episodes (n  = 28), blood cultures identified a causative organism: Gram-negative (n  = 15), Gram-positive (n  = 8), polybacterial (n  = 4), fungi (n  = 1). Twenty-six percent of Gram-negatives were extend spectrum β-lactamase (ESBL)-producers. In 44% of episodes, a deep-organ localization was present, mostly pulmonary. Severe or profound neutropenia, hypotension, and hypoxemia were present in 89, 26, and 21% of episodes, respectively; 20% of episodes required intensive care and 20% of episodes required the use of inotropes. Overall, 90-day mortality was 13% and infection-attributable mortality resulted 8.6%. More than half of the patients received HT-IgM within 24 hours from fever onset. HT-IgM-related allergic reactions occurred in three episodes. Risk factors for 90-day mortality were as follows: hypotension and hypoxemia at fever presentation, admission to intensive care unit (ICU), use of inotropes, presence of deep-organ infection, and escalation of antibiotic therapy within 5 days. Conclusion  The combination of broad-spectrum antibiotics and HT-IgM was feasible, tolerated, and promising, being associated with a limited infectious mortality. Further prospective controlled studies are needed to assess the efficacy of this combination over a standard antibiotic approach. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
13057707
Volume :
17
Issue :
1
Database :
Academic Search Index
Journal :
Journal of Pediatric Infectious Diseases
Publication Type :
Academic Journal
Accession number :
154691718
Full Text :
https://doi.org/10.1055/s-0041-1741122