Neutropenia febril posquimioterapia. Estancia hospitalaria y experiencia en nuestro medio

espanolIntroduccion Las infecciones son una causa importante de morbimortalidad en los pacientes con cancer (mortalidad estimada en 3%). La neutropenia febril conlleva con frecuencia el ingreso hospitalario de los pacientes oncologicos, incrementando el riesgo de infeccion nosocomial asi como los costes sanitarios por ingresos. Metodos Estudio observacional ambispectivo (01/07/2015 - 31/12/2018) de los episodios de neutropenia febril posquimioterapia en poblacion pediatrica. Se recogieron edad, sexo, percentil de peso (OMS), estancia hospitalaria (dias), temperature (oC), aislamiento de germen, foco infeccioso, profilaxis o no antibiotica y antifungica, cifras de hemoglobina (g/dl), plaquetas (/mm3), neutrofilos (/mm3), linfocitos (/mm3), monocitos (/mm3), proteina C reactiva (PCR) (mg/L) y procalcitonina (PCT) (ng/ml) al ingreso y dias con neutropenia Resultados De 69 pacientes, se registraron 101 episodios. La estancia media fue de 7,43 dias (mediana 6 dias). Se aislo germen en un 44,6% de los episodios, no identificandose foco infeccioso en un 36% de los mismos. Se hallo correlacion inversa entre hemoglobina, plaquetas y linfocitos al ingreso con la estancia hospitalaria (-0,356 (p 0,001); -0,216 (p 0,042) y -0,216 (p 0,042) respectivamente). La estancia media fue mayor si al ingreso presentaron PCR> 90 mg/L (10,94 vs. 6,66 dias p 0,017), si PCT> 1ng/ml (16,50 vs. 6,77 dias p 0,0002), si ≤100 neutrofilos (8,27 vs. 5,04 dias p 0,039) y si hubo aislamiento microbiologico (9,54 vs. 5,78 dias p 0,006). Conclusion La relacion entre hemoglobina, plaquetas y linfocitos al ingreso con la estancia media es inversamente proporcional. Ademas, aquellos pacientes con ≤100 neutrofilos al ingreso, PCR >90 mg/L y PCT >1ng/ml presentaron mayor estancia media. Estos factores podrian ser importantes en el manejo de la neutropenia febril en el paciente con cancer infantil. EnglishIntroduction Infections are significant cause of morbidity and mortality in cancer patients (mortality is estimated at around 3%). Febrile neutropenia often leads to the hospitalisation of cancer patients, increasing the risk of nosocomial infection, as well as health costs due to the hospital admission. Methods An ambispective (01 July 2015 – 12 July 2018) observational study was conducted on all episodes of chemotherapy-induced febrile neutropenia in a paediatric population. A record was made of age, gender, weight percentile (WHO), length of hospital stay (days), temperature (oC), microbial isolation, infectious source, antibiotic or antifungal prophylaxis, haemoglobin (g/dl), platelets (/mm3), neutrophils (/mm3), lymphocytes (/mm3), monocytes (/mm3), CRP (mg/L) and procalcitonin (PCT) (ng/ml) on admission, and days with neutropenia Results The study included 69 patients, and 101 episodes were recorded. The mean stay was 7.43 days (median 6 days). Microbial isolation was found in 44.6% of the episodes, with no infectious source identified in 36% of them. An inverse correlation was found between haemoglobin, platelets, and lymphocytes on admission and the hospital stay (-0.356: P = .001, -0.216: P = .042, and -0.216: P = .042, respectively). The mean stay was greater if there was a CRP >90 mg/L (10.94 vs. 6.66 days, P = .017), if PCT >1ng/ml (16.50 vs. 6.77 days, P = .0002), if ≤ 100 neutrophils (8.27 vs. 5.04 days P = .039) on admission, and if there was microbe isolation (9.54 vs. 5.78 days P = .006). Conclusion The relationship between haemoglobin, platelets, and lymphocytes on admission and the mean stay is inversely proportional. In addition, those patients with ≤100 neutrophils, CRP >90 mg/L, and PCT >1ng/ml on admission had a longer hospital stay.