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CC BY-NC-ND 4.0 · J Pediatr Infect Dis 2022; 17(01): 040-047
DOI: 10.1055/s-0041-1741122
Original Article

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

Nicoletta Abram 
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Valentina Baretta
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Federico Mercolini 
2   Division of Pediatric Hematology Oncology, Hospital of Bolzano, Bolzano, Italy
,
Massimiliano De Bortoli
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Matteo Chinello 
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Rita Balter
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Elisa Bonetti
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Ada Zaccaron
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Virginia Vitale
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Giulia Caddeo
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Margherita Mauro
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Laura Battisti
2   Division of Pediatric Hematology Oncology, Hospital of Bolzano, Bolzano, Italy
,
Gloria Tridello
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
,
Simone Cesaro 
1   Department of Mother and Child, Division of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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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.

Keywords

immunoglobulin M - pediatric malignancy - infectious complications - febrile neutropenia


Publikationsverlauf

Eingereicht: 17. Juli 2021

Angenommen: 21. September 2021

Artikel online veröffentlicht:
07. Dezember 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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