Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial. Santolaya M.E., Alvarez A.M., Acuna M., Aviles C.L., Salgado C., Tordecilla J., Varas M., Venegas M., Villarroel M., Zubieta M., Toso A., Bataszew A., Farfan M.J., de la Maza V., Vergara A., Valenzuela R., & Torres J.P. 2017. ![Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper abstract bibtex Objectives To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. Methods Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. Results A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97%) and 80/84 (95%), respectively, not significant; OR 1.48; 95% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2%-1%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. Conclusions The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases
@misc{santolaya_m.e._efficacy_2017,
title = {Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial},
url = {http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1469-0691},
abstract = {Objectives To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. Methods Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. Results A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97\%) and 80/84 (95\%), respectively, not significant; OR 1.48; 95\% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2\%-1\%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. Conclusions The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases},
journal = {Clinical Microbiology and Infection},
author = {{Santolaya M.E.} and {Alvarez A.M.} and {Acuna M.} and {Aviles C.L.} and {Salgado C.} and {Tordecilla J.} and {Varas M.} and {Venegas M.} and {Villarroel M.} and {Zubieta M.} and {Toso A.} and {Bataszew A.} and {Farfan M.J.} and {de la Maza V.} and {Vergara A.} and {Valenzuela R.} and {Torres J.P.}},
year = {2017},
keywords = {*antimicrobial therapy, *childhood cancer, *febrile neutropenia, *neoplasm, *safety, *treatment withdrawal, *viral respiratory tract infection, *viral respiratory tract infection/dt [Drug Therapy], Adenoviridae, Child, Chile, Coronaviridae, DNA microarray, Enterovirus B, Human bocavirus, Human metapneumovirus, Human respiratory syncytial virus A, Rhinovirus, adoption, amikacin/cb [Drug Combination], amikacin/dt [Drug Therapy], antiinfective agent, article, bacteremia, bacterial infection, bacterial infection/dt [Drug Therapy], ceftazidime/cb [Drug Combination], ceftazidime/dt [Drug Therapy], ceftriaxone/dt [Drug Therapy], child hospitalization, clinical examination, clinical trial, controlled clinical trial, controlled study, death, diagnosis, drug withdrawal, female, hospitalization, human, influenza A, influenza B, influenza C, laboratory test, length of stay, leukemia, leukemia relapse, lymphoma, major clinical study, male, microarray analysis, microorganism, molecular diagnosis, multicenter study, multiplex polymerase chain reaction, nonhuman, outcome assessment, pediatric intensive care unit, polymerase chain reaction, priority journal, prospective study, randomized controlled trial, risk benefit analysis, safety, sepsis, solid tumor, treatment duration, viral respiratory tract infection/dt [Drug Therapy]}
}
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Methods Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. Results A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97%) and 80/84 (95%), respectively, not significant; OR 1.48; 95% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2%-1%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. Conclusions The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases","journal":"Clinical Microbiology and Infection","author":[{"firstnames":[],"propositions":[],"lastnames":["Santolaya M.E."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Alvarez A.M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Acuna M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Aviles C.L."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Salgado C."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Tordecilla J."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Varas M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Venegas M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Villarroel M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Zubieta M."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Toso A."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Bataszew A."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Farfan M.J."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["de la Maza V."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Vergara A."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Valenzuela R."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Torres J.P."],"suffixes":[]}],"year":"2017","keywords":"*antimicrobial therapy, *childhood cancer, *febrile neutropenia, *neoplasm, *safety, *treatment withdrawal, *viral respiratory tract infection, *viral respiratory tract infection/dt [Drug Therapy], Adenoviridae, Child, Chile, Coronaviridae, DNA microarray, Enterovirus B, Human bocavirus, Human metapneumovirus, Human respiratory syncytial virus A, Rhinovirus, adoption, amikacin/cb [Drug Combination], amikacin/dt [Drug Therapy], antiinfective agent, article, bacteremia, bacterial infection, bacterial infection/dt [Drug Therapy], ceftazidime/cb [Drug Combination], ceftazidime/dt [Drug Therapy], ceftriaxone/dt [Drug Therapy], child hospitalization, clinical examination, clinical trial, controlled clinical trial, controlled study, death, diagnosis, drug withdrawal, female, hospitalization, human, influenza A, influenza B, influenza C, laboratory test, length of stay, leukemia, leukemia relapse, lymphoma, major clinical study, male, microarray analysis, microorganism, molecular diagnosis, multicenter study, multiplex polymerase chain reaction, nonhuman, outcome assessment, pediatric intensive care unit, polymerase chain reaction, priority journal, prospective study, randomized controlled trial, risk benefit analysis, safety, sepsis, solid tumor, treatment duration, viral respiratory tract infection/dt [Drug Therapy]","bibtex":"@misc{santolaya_m.e._efficacy_2017,\n\ttitle = {Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial},\n\turl = {http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1469-0691},\n\tabstract = {Objectives To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. Methods Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. Results A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97\\%) and 80/84 (95\\%), respectively, not significant; OR 1.48; 95\\% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2\\%-1\\%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. Conclusions The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases},\n\tjournal = {Clinical Microbiology and Infection},\n\tauthor = {{Santolaya M.E.} and {Alvarez A.M.} and {Acuna M.} and {Aviles C.L.} and {Salgado C.} and {Tordecilla J.} and {Varas M.} and {Venegas M.} and {Villarroel M.} and {Zubieta M.} and {Toso A.} and {Bataszew A.} and {Farfan M.J.} and {de la Maza V.} and {Vergara A.} and {Valenzuela R.} and {Torres J.P.}},\n\tyear = {2017},\n\tkeywords = {*antimicrobial therapy, *childhood cancer, *febrile neutropenia, *neoplasm, *safety, *treatment withdrawal, *viral respiratory tract infection, *viral respiratory tract infection/dt [Drug Therapy], Adenoviridae, Child, Chile, Coronaviridae, DNA microarray, Enterovirus B, Human bocavirus, Human metapneumovirus, Human respiratory syncytial virus A, Rhinovirus, adoption, amikacin/cb [Drug Combination], amikacin/dt [Drug Therapy], antiinfective agent, article, bacteremia, bacterial infection, bacterial 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