Time to Antibiotics (TTA) – Überlegungen der Arbeitsgruppe Fieber bei Granulozytopenie im Kindes- und Jugendalter (GPOH/DGPI) zu einer Neubewertung.

Zusammenfassung

Hintergrund Die geltende Leitlinie für kinderonkologische Patienten mit febriler Granulozytopenie (FN) von 2016 empfiehlt eine Time-to-Antibiotics (TTA)<60 min.

Methode Kritische Analyse verfügbarer Studien und Metaanalysen, Diskussion der Konsequenzen in der Arbeitsgruppe Fieber bei Granulozytopenie der Fachgesellschaften für pädiatrische Onkologie und Hämatologie und pädiatrische Infektiologie.

Ergebnisse Die verfügbaren Studien können keinen klinisch signifikanten Vorteil einer TTA<60 min für alle kinderonkologischen Patienten mit FN darstellen. Studien, die einen solchen Zusammenhang nahelegen, sind mit einem Triage Bias und anderen methodischen Limitationen behaftet und nutzen unterschiedliche TTA Definitionen. Hingegen ist eine TTA<60 min elementarer Bestandteil des Einstunden-Maßnahme-Bündels bei septischem Schock oder Sepsis mit Organdysfunktion.

Zusammenfassung Wenn alle kinderonkologischen Patienten mit neu aufgetretenem Fieber zeitnah durch gut ausgebildetes und trainiertes Fachpersonal eine strukturierte Anamnese und körperliche Untersuchung (inkl. Vitalzeichen) erhalten und unter der Voraussetzung, dass lokal eine Sepsis Triage und Management Bündel etabliert und implementiert wurde, ist eine TTA<3 h bei kinderonkologischen Patienten mit FN angemessen.

Abstract

Background The current German guidance from 2016 recommends a Time to Antibiotics (TTA) of<60 min in children and adolescents with febrile neutropenia (FN).

Methods Critical analysis of available studies and recent meta-analyses, and discussion of the practical consequences in the FN working group of the German Societies for Paediatric Oncology and Haematology and Paediatric Infectious Diseases.

ResultsThe available evidence does not support a clinically significant outcome benefit of a TTA<60 min in all paediatric patients with FN. Studies suggesting such a benefit are biased (mainly triage bias), use different TTA definitions and display further methodical limitations. In any case, a TTA<60 min remains an essential component of the 1st hour-bundle in paediatric cancer patients with septic shock or sepsis with organ dysfunction.

Conclusion Provided that all paediatric FN patients receive a structured medical history and physical examination (including vital signs) by experienced and trained medical personnel in a timely fashion, and provided that a sepsis triage and management bundle is established and implemented, a TTA lower than 3 hours is sufficient and reasonable in stable paediatric cancer patients with FN.

Schlüsselwörter

Kinder mit Krebserkrankung - Fieber - Granulozytopenie - Time to Antibiotics

Key words

children with cancer - fever - neutropenia - time to antibiotics

Publication History

Article published online:
26 September 2023

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