La Sociedad Latinoamericana de Infectologia Pediatrica, a traves de su Comite de Infecciones en Ninos Inmunocomprometidos, propone un documento de consenso sobre "Diagnostico y tratamiento de la neutropenia febril en ninos con cancer". Este documento-guia aborda el manejo de la neutrope-nia febril orientado a la atencion de ninos con cancer en America Latina. Se realizo una busqueda exhaustiva de la literatura, y se considero particularmente la experiencia publicada proveniente de centros de nuestro continente, que aporta una mirada regional y adecuada a la realidad de nuestros paises. El manuscrito contiene un panorama epidemiologico de la Region y recomendaciones para la evaluacion clinica y de laboratorio necesarios para el manejo de estos pacientes, establece criterios de categorizacion de riesgo de infecciones bacterianas invasoras, analiza las medidas de cuidado general de los pacientes en el ambiente hospitalario y extra-hospitalario, propone diferentes enfoques terapeuticos de acuerdo a las realidades epidemiologicas institucionales, parametros clinicos y de categorizacion de riesgo, establece diferentes algoritmos de seguimiento segun la evolucion de cada paciente, especifica las situaciones en que esta indicada algun tipo de profilaxis y da los lineamientos generales sobre el tipo y oportunidad de terapia antifungica a utilizar en ellos. Se ha puesto especial enfasis en entregar, de forma practica, y con la mayor evidencia posible, las recomendaciones para el mejor manejo de los ninos con cancer, fiebre y neutropenia, buscando la equidad y la excelencia en todos los centros oncologicos latinoamericanos.

/pdf/diagnostico-y-tratamiento-de-la-neutropenia-febril-en-ninos-47ts3goozg.pdf

Diagnóstico y tratamiento de la neutropenia febril en niños con cáncer Consenso de la Sociedad Latinoamericana de Infectología Pediátrica

AIM To assess the cost-effectiveness of UGT1A1*6/*28 genotyping compared with no genotyping or no dose adjustment before irinotecan administration in China. MATERIALS & METHODS A decision tree model was developed to evaluate costs and health outcomes represented as quality-adjusted life years gained. Model inputs for the frequency of genotypes, the probability of neutropenia under FOLFIRI chemotherapy and direct costs and utilities were obtained from published sources. One-way sensitivity analyses were performed. RESULTS The strategy of genotyping with dose reduction dominated all remaining strategies. Compared with the strategies of no genotyping and genotyping with unchanged dose, it resulted in only marginal quality-adjusted life year increases (0.0011 and 0.0012) but a cost reduction of $651.12 and $805.22 per patient, respectively. One-way sensitivity analyses revealed that the model was relatively robust. CONCLUSION UGT1A1*6/*28 genotyping was cost saving for Chinese colorectal cancer patients.

Cost-effectiveness analysis of UGT1A1*6/*28 genotyping for preventing FOLFIRI-induced severe neutropenia in Chinese colorectal cancer patients.

This study aims to design a set of the visual artificial intelligence system based on medical information mining for hospital emergency care management. A visual artificial intelligence emergency first aid nursing management system is designed by analyzing the needs of the emergency first aid nursing management system. The results show that system personnel allocation, comparative management, record management, query management analysis, basic setup analysis, nursing management basis, and nonfunctional requirements all need to be optimized for the emergency first aid management system. In this study, the comparative management module, log management module, and the query management module are designed, and the emergency first aid management system of different APP terminal functions in different modules is described in detail. The nursing document query business is tested, and the corresponding time of query of nursing assessment sheet, nurse shift record, nurse record, and physical sign observation sheet is 375.50 ms, 351.48 ms, 336.36 ms, and 245.57 ms, respectively. It shows that the visual artificial intelligence emergency nursing management system based on medical information mining can provide convenience for clinical work to a large extent and has potential application value in hospital emergency nursing work.

/pdf/medical-information-mining-based-visual-artificial-57vsiiqf96.pdf

Medical Information Mining-Based Visual Artificial Intelligence Emergency Nursing Management System

We retrospectively obtained data of patient background and pretreatment characteristics from medical records and identified the predictive factors of febrile neutropenia (FN) in patients with non-small cell lung cancer (NSCLC) treated with docetaxel alone or in combination with the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab. Patients were eligible for inclusion in the study if they were 20 years or older, diagnosed with NSCLC, and received docetaxel monotherapy alone or in combination with bevacizumab at the Department of Respiratory Medicine, Kobe City Medical Center General Hospital, between July 1, 2011, and March 31, 2018. Eighty-one patients with recurrent or advanced NSCLC were included. Multivariate stepwise logistic regression analysis with backward selection revealed that lower baseline Eastern Cooperative Oncology Group performance status (ECOG-PS) scores of 1 and 2 (odds ratio (OR), 5.098; 95% confidence interval (CI), 1.045-24.879, p = 0.021) and baseline platelet count below 18.8 × 104/µL (OR, 3.861; 95% CI, 1.211-12.311, p = 0.022) were significant factors influencing the FN occurrence rate. Our results demonstrated that ECOG-PS 1-2 and lower baseline platelet count were significant risk factors of FN in patients with NSCLC receiving docetaxel-based chemotherapy. Moreover, the combination of anti-VEGF antibodies and docetaxel might be associated with increased FN frequency. Despite the limitations of this study including its retrospective design, single-center site, and small sample size, baseline ECOG-PS score and platelet count may be regarded as important indices to identify patients for prophylactic granulocyte-colony stimulating factor (G-CSF) treatment before docetaxel-based chemotherapy.

/pdf/risk-factors-for-febrile-neutropenia-induced-by-docetaxel-bnnkjx6teb.pdf

Risk Factors for Febrile Neutropenia Induced by Docetaxel Chemotherapy in Patients with Non-small Cell Lung Cancer

Introducción: El cáncer en el año 2020 provoco 1,4 millones de muertes, el 47% en personas menores de 65 años de edad, la neutropenia febril en el paciente oncológico aumenta los casos de infecciones graves, incrementando la morbimortalidad cuando no se ha empezado un tratamiento de oportuno. El objetivo del presente estudio fue describir una población con esta patología en un centro de referencia regional. 
Metodología: Este estudio transversal, se realizó en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”, Sociedad de Lucha contra el Cáncer, Solca-Guayaquil, período enero 2020- junio 2021, con una muestra no probabilística, de pacientes con neoplasias, neutropenias y cultivos positivos. Se registraron variables demográficas, clínicas, de laboratorio. Se utiliza estadística descriptiva univariada. 
Resultados: Se analizan 126 casos, de edad promedio 55 años, el 50.8% fue de sexo femenino; el 88.1 % ingresó con neutropenia febril; la estancia hospitalaria promedio fue de 7 días. La Escherichia coli fue el microorganismo más frecuente con el 17.5 %, seguido por Klebsiella pneumoniae en el 9.5 %, Enterobacter aerogenes y Pseudomonas aureginosa en el 4.8 %. El 70.2 % de las bacterias aisladas presentó resistencia bacteriana, el 47 % fueron bacterias betalactamasa de espectro ampliado (BLEA), el 40 % fue betalactamasa de espectro extendido (BLEE), y el 5 % productor de carbapenemasas (KPC), el 57.5 % con resistencia bacteriana tuvo una estancia hospitalaria mayor a 7 días. 
Conclusión: El principal microorganismo fue Escherichia coli y la resistencia mayormente la tuvieron las bacterias betalactamasa de espectro ampliado positiva; permitiendo conocer la epidemiología local del perfil microbiológico y su relación con los pacientes oncológicos con neutropenia febril.

Prevalencia de gérmenes con multirresistencia antibiótica en bacteriemia asociada a neutropenia febril en pacientes oncológicos hospitalizados

Febrile neutropenia is a life-threatening condition that requires immediate attention, especially in patients with chemotherapy-related neutropenia. Patients with febrile neutropenia have a much greater risk of developing bacterial disease, and fever may be the only indicator of severe bacterial infection. Adequate management of febrile neutropenia emphasizes early recognition of patients, risk stratification, and antibiotic therapy administration during the first 60 minutes of admission to an emergency room. Not all children with febrile neutropenia carry the same risk of morbidity and mortality, so in recent years, efforts have been made to distinguish between high-risk patients where more aggressive hospital management is required. In children classified as low-risk, outpatient management may be considered initially or after 72 hours, whilst high-risk patients should be hospitalized and managed with parenteral antibiotics.

/pdf/neutropenia-febril-en-ninos-con-cancer-manejo-en-el-servicio-yf8xkafp98.pdf

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

Background

Understanding antibiotic profiles and their resistance patterns can improve hospital quality care and optimize clinical outcomes. This paper characterizes the use of meropenem in the National Children’s Hospital of Caja Costarricense del Seguro Social (CCSS) in Costa Rica, and its role in antibiotic stewardship.

Methods

This is a retrospective observational study from hospitalized patients under 13 years of age that received meropenem as part of their treatment. Patients were identified through medical and pharmacy records. Data was summarized using frequencies and percentages for categorical variables, means and standard deviations for normally distributed continuous variables, and medians with interquartile ranges (IQR) for non-normally distributed continuous variables.

Results

A total of 181 of the 309 selected patients met inclusion criteria. Median age was 21 months (IQR: 4.0-79.0). Mean length of stay was 31 days (16.0-58.0). The most frequent diagnosis was septic shock (29%). 87% of patients received at least one antibiotic prior to receiving meropenem; 71% of patients received a second antibiotic simultaneously with meropenem. In 113 (62%) cases, meropenem was prescribed as empirical therapy. The most frequent isolate was extended-spectrum s-lactamase Escherichia coli (24%). 74% of patients who received meropenem as targeted therapy had a favorable outcome.

Conclusions

Meropenem can be used as monotherapy for complicated, multi-drug resistant, gram negative, bacterial infections, due to its susceptibility profile, convenient dosing schedule, and minimum adverse effects. However, it should be restricted to cases where no other drug is available in order to safeguard its value.

Use of Meropenem in a Tertiary Pediatric Hospital in Costa Rica and Its Role in the Era of Antimicrobial Stewardship.

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Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

Use of Meropenem in a Tertiary Pediatric Hospital in Costa Rica and Its Role in the Era of Antimicrobial Stewardship.