Post chemotherapy febrile neutropenia. Length of stay and experience in our population

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Length of stay and experience in our population" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "141" "paginaFinal" => "146" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Íñigo Pérez-Heras, Roberto Carlos Raynero-Mellado, Raquel Díaz-Merchán, Nerea Domínguez-Pinilla" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Íñigo" "apellidos" => "Pérez-Heras" "email" => array:1 [ 0 => "inigop30@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Roberto Carlos" "apellidos" => "Raynero-Mellado" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "Díaz-Merchán" ] 3 => array:2 [ "nombre" => "Nerea" "apellidos" => "Domínguez-Pinilla" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Oncohematología Pediátrica, Pediatría y sus áreas específicas, Complejo Hospitalario Universitario de Toledo, Toledo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neutropenia febril posquimioterapia. Estancia hospitalaria y experiencia en nuestro medio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1241 "Ancho" => 1608 "Tamanyo" => 51544 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation between length of stay and platelet count at admission." ] ] ] "textoCompleto" => "IntroductionFebrile neutropenia is a frequent complication in children that receive chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Up to one third of episodes of neutropenia after chemotherapy manifest with fever.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This corresponds to 0.76 episodes of fever per 30 days of neutropenia. Several studies have reported that the infection is severe in up to 25% of episodes, with an overall mortality of approximately 3%.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The available evidence suggests that early administration of appropriate antibiotherapy decreases mortality due to bacterial infection.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> On the other hand, delayed administration of antibiotherapy has been associated with poorer outcomes.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>For this reason, patients with febrile neutropenia after chemotherapy endure long hospitalizations and are given broad-spectrum antibiotics.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> The prolonged lengths of stay have a significant impact on the quality of life of these patients and their families.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> As health professionals, it is essential that we know how to correctly manage these episodes both in the emergency department and in the subsequent hospitalization.Blood cancers,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> the duration of neutropenia,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> sepsis,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> low blood pressure,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> non-white race<a class="elsevierStyleCrossRef" href="#bib0045">9</a> and age more than 12 years<a class="elsevierStyleCrossRef" href="#bib0045">9</a> have been identified as risk factors for an increased mean length of stay.On the other hand, the use of granulocyte-colony stimulating factor (G-CSF) has been associated with a significantly lower mean length of stay (1–2 days).<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> In the paediatric population, current guidelines recommend using G-CSF for primary or secondary prophylaxis or for treatment only in patients classified as high-risk.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>In addition, postchemotherapy febrile neutropenia episodes place a considerable financial burden on the national health system<a class="elsevierStyleCrossRefs" href="#bib0040">8,13</a> in terms of both direct and indirect costs.In light of the above, identifying the factors associated to prolonged lengths of stay is of the essence.The main objective of our study was to identify the risk factors associated with an increased length of stay in episodes of febrile neutropenia associated with chemotherapy in our hospital over a 3-year period.The secondary objective was to describe the distribution of microbiological isolates and foci of infection in our patients.MethodsWe conducted a retrospective and prospective observational study (01/07/2015–31/12/2018) of the episodes of febrile neutropenia associated to chemotherapy in paediatric patients managed in a tertiary care hospital.The inclusion criteria were age 0–18 years, delivery of chemotherapy by the Department of Paediatric Oncology and Haematology, an axillary temperature of 38°C or higher and an absolute neutrophil count of 500/mm3 or lower.The exclusion criteria were age more than 18 years, neutropenia of any aetiology unrelated to chemotherapy, an absolute neutrophil count of more than 500cells/mm3 (moderate or mild neutropenia not requiring hospital admission).We collected data for the following variables: age, sex, weight percentile, body temperature (°C), pathogen isolation (blood culture, urine culture, stool culture, throat culture, rapid respiratory syncytial virus [RSV] and influenza A and B tests [Alere BinaxNOW ® RSV and BinaxNOW ® Influenza A & B]), administration or lack of administration of antibiotic and/or antifungal prophylaxis, haemoglobin concentration (g/dL), platelet count (/mm3), neutrophil count (/mm3), lymphocyte count (/mm3), monocyte count (/mm3), C-reactive protein (CRP) (mg/L) and procalcitonin (PCT) (ng/ml) levels at admission, days with neutropenia with a neutrophil count of less than 500/mm3, focus of infection and length of stay in days.We calculated the Pearson r to analyse the correlation between the length of stay and the weight percentile, temperature, haemoglobin concentration, platelet, neutrophil, lymphocyte and monocyte counts, levels of CPR and PCT and days with neutropenia with less than 500 neutrophils/mm3.We also made analyses by subgroups using the Student t test, comparing the mean length of stay of patients based on whether they had a neutrophil count of 100/mm3 or less at admission, a CPR level of 90mg/L or greater, a PCT level of 1ng/mL or greater, microbial isolation, the focus of infection, and use antibiotic and/or antifungal prophylaxis.We used the personal data of participants in adherence with current legislation and safeguarded patient confidentiality. No report or publication will therefore include any identifiable data. The study was approved by the Clinical Research Ethics Committee.The analysis was carried out with the statistical software SPSS version 23. We defined statistical significance as a p-value of less than 0.05 in any of the tests.ResultsIn the period under study, 69 patients met the inclusion criteria, corresponding to a total of 101 episodes of postchemotherapy febrile neutropenia.The mean length of stay was 7.38 days (median, 6 days). The remaining median values were age 6 years, weight on the 25th percentile, fever of 38.2°C, haemoglobin concentration of 8.9g/dL, platelet count of 54 000/mm3, neutrophil count of 100/mm3, lymphocyte count of 200/mm3, monocyte count of 0/mm3, CRP level of 46mg/L, PCT level of 0.26ng/mL, 3 days with neutrophil count of less than 500/mm3.A microbial isolate was obtained in 45 episodes (44.6%). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> presents the distribution of the foci of infection.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> presents the distribution of patients by type of tumour.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>We analysed the correlation of the length of stay to the rest of the quantitative variables under study, and found a statistically significant correlation with the haemoglobin concentration (–0.307; P=.002), the platelet count (–0.215; P=.031) and the lymphocyte count (–0.205; P=.04) at admission and the CPR level (0.204; P=.041), results that are represented in <a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a> to <a class="elsevierStyleCrossRef" href="#fig0030">6</a>. The correlations with the remaining variables were not statistically significant, although the p-value corresponding to the neutrophil count at admission neared the threshold of significance (–0.191; P=.056).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia>The remaining results of the analysis can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionThe mean stay reported in the literature ranges between 5 and 19.7 days per episode,<a class="elsevierStyleCrossRefs" href="#bib0035">7–9,13,14</a> depending on the case series. The mean found in our sample fell within this range and was consistent with most published studies.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9,13,14</a>In our sample, the percentage of cases in which a pathogen was isolated was slightly greater compared to the literature, in which reported proportions range from 10% to 40%.<a class="elsevierStyleCrossRefs" href="#bib0010">2,15,16</a> This may be explained in part by viruses causing a substantial percentage of infections in febrile neutropenia episodes (44–57%),<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and thus in our hospital we perform rapid tests for RSV and influenza during the epidemic season.On the other hand, the distribution of cases by focus of infection was consistent with the literature<a class="elsevierStyleCrossRef" href="#bib0090">18</a>: 32% of episodes are of fever without a focus (35% in our sample), and 20% are episodes of bacteraemia (12% cases of invasive bacterial infection and 6% cases of central catheter-related infection).We ought to highlight that the length of stay for episodes in which a causative pathogen was identified was 4 days longer (a statistically significant difference). This could be due to a greater severity of disease or to an intent to ensure completion of the duration of antibiotherapy required by each infection.When it came to the factors associated with an increased length of stay, our results suggested a negative correlation with the haemoglobin concentration, the platelet count and the lymphocyte count, factors that had not been previously described. We also found a positive correlation between the mean length of stay and the CPR levels at admission, which seems logical and is consistent with the previous literature.In addition, we found a statistically significant association between the PCT and neutrophil values at admission on one hand and an increased length of stay on the other. These factors have been previously described in the literature as predictors of poor outcomes,<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> but not of prolonged lengths of stay. These results agree with previous findings, as episodes with poor outcomes may be associated with longer lengths of stay.Although we did not find a statistically significant association between the neutrophil count at admission and the length of stay, the p-value neared the threshold of significance, so it is likely that this association would be significant if analysed in a larger sample.One of the main limitations of our study was the small sample size. In addition, in most patients we were unable to determine whether they received G-CSF, which has been associated with shorter mean lengths of stay and may have had an impact on the results. Another limitation is that the time elapsed to administration of the first dose of antibiotherapy in the emergency department was not recorded, although the previous literature suggests that this variable is not associated with length of stay.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a>Identifying these factors as new indicators of an increased length of stay may help guide clinical decision-making in these episodes and optimise the use of available resources, as well as plan the management of patients to try to minimise the impact to their quality of life.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1317819" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1216136" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1317818" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1216135" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-11" "fechaAceptado" => "2019-05-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1216136" "palabras" => array:4 [ 0 => "Chemotherapy-induced febrile neutropenia" 1 => "Length of stay" 2 => "Neoplasms" 3 => "Child" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1216135" "palabras" => array:5 [ 0 => "Neutropenia febril" 1 => "Quimioterapia" 2 => "Estancia media" 3 => "Neoplasia" 4 => "Niño" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionInfections are a 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. MethodsAn 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 (°C), 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<500/mm3. Statistical analysis was performed using the SPSSv.23 program. ResultsThe 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 >90mg/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) ConclusionThe relationship between haemoglobin, platelets, and lymphocytes on admission and the mean stay is inversely proportional. In addition, those patients with ≤100 neutrophils, CRP>90mg/L, and PCT>1ng/ml on admission had a longer hospital stay." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLas infecciones son una causa importante de morbimortalidad en los pacientes con cáncer (mortalidad estimada en 3%). La neutropenia febril conlleva con frecuencia el ingreso hospitalario de los pacientes oncológicos, incrementando el riesgo de infección nosocomial así como los costes sanitarios por ingresos. MétodosEstudio observacional ambispectivo (01/07/2015–31/12/2018) de los episodios de neutropenia febril post-quimioterapia en población pediátrica. Se recogieron edad, sexo, percentil de peso(OMS), estancia hospitalaria(días), temperature (°C), aislamiento de germen, foco infeccioso, profilaxis o no antibiótica y antifúngica, cifras de hemoglobina(g/dl), plaquetas(/mm3), neutrófilos(/mm<a class="elsevierStyleCrossRef" href="#bib0015">3</a>), linfocitos(/mm3), monocitos(/mm3), proteína C reactiva (PCR)(mg/L) y procalcitonina(PCT)(ng/ml) al ingreso y días con neutropenia <500/mm3. El análisis estadístico se realizó con el programa SPSSv.23. ResultadosDe 69 pacientes, se registraron 101 episodios. La estancia media fue de 7,43 días (mediana 6 días). Se aisló germen en un 44.6% de los episodios, no identificándose foco infeccioso en un 36% de los mismos. Se halló correlación inversa entre hemoglobina, plaquetas y linfocitos al ingreso con la estancia hospitalaria (−0,356 (p0,001); −0,216 (p0,042) y −0,216(p0,042) respectivamente). La estancia media fue mayor si al ingreso presentaron PCR>90mg/L(10,94 vs.6,66 días p0,017), si PCT>1ng/ml (16,50 vs.6,77 días p0,0002), si ≤100neutrófilos(8,27vs.5,04 días p0,039) y si hubo aislamiento microbiológico (9,54vs.5,78 días p0,006). ConclusiónLa relación entre hemoglobina, plaquetas y linfocitos al ingreso con la estancia media es inversamente proporcional. Además, aquellos pacientes con ≤100 neutrófilos al ingreso, PCR>90mg/L y PCT>1ng/ml presentaron mayor estancia media. Estos factores podrían ser importantes en el manejo de la neutropenia febril en el paciente con cáncer infantil." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pérez-Heras Í, Raynero-Mellado RC, Díaz-Merchán R, Domínguez-Pinilla N. Neutropenia febril posquimioterapia. Estancia hospitalaria y experiencia en nuestro medio. An Pediatr (Barc). 2020;92:141–146." ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1662 "Ancho" => 1588 "Tamanyo" => 89021 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Focus of infection. AGE, acute gastroenteritis; AOM, acute otitis media; CRI, catheter-related infection; FWF, fever without focus; IBI, invasive bacterial infection; URTI, upper respiratory tract infection; UTI, urinary tract infection." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1087 "Ancho" => 1584 "Tamanyo" => 49319 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Distribution by type of tumour." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1230 "Ancho" => 1545 "Tamanyo" => 55654 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation between length of stay and haemoglobin concentration at admission." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1241 "Ancho" => 1608 "Tamanyo" => 51544 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation between length of stay and platelet count at admission." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1247 "Ancho" => 1587 "Tamanyo" => 49860 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation between length of stay and lymphocyte count at admission." ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1254 "Ancho" => 1567 "Tamanyo" => 47075 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Correlation between length of stay and CRP level at admission." ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (N=101) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of stay (days) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neutrophil count (/mm3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.039</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCT (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.0002</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pathogen isolation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.004</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.165</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antifungal prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.938</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of tumour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">.073</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solid tumour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2259119.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Analysis of mean length of stay by group (Student t test)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections in children with cancer: a continued need for the comprehensive physical examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.J. 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Post chemotherapy febrile neutropenia. Length of stay and experience in our population

Neutropenia febril posquimioterapia. Estancia hospitalaria y experiencia en nuestro medio

Íñigo Pérez-Heras

Corresponding author

inigop30@gmail.com

Corresponding author.

, Roberto Carlos Raynero-Mellado, Raquel Díaz-Merchán, Nerea Domínguez-Pinilla

Unidad de Oncohematología Pediátrica, Pediatría y sus áreas específicas, Complejo Hospitalario Universitario de Toledo, Toledo, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Febrile neutropenia is a frequent complication in children that receive chemotherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Up to one third of episodes of neutropenia after chemotherapy manifest with fever&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This corresponds to 0&#46;76 episodes of fever per 30 days of neutropenia&#46; Several studies have reported that the infection is severe in up to 25&#37; of episodes&#44; with an overall mortality of approximately 3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The available evidence suggests that early administration of appropriate antibiotherapy decreases mortality due to bacterial infection&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> On the other hand&#44; delayed administration of antibiotherapy has been associated with poorer outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For this reason&#44; patients with febrile neutropenia after chemotherapy endure long hospitalizations and are given broad-spectrum antibiotics&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> The prolonged lengths of stay have a significant impact on the quality of life of these patients and their families&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> As health professionals&#44; it is essential that we know how to correctly manage these episodes both in the emergency department and in the subsequent hospitalization&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood cancers&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the duration of neutropenia&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> sepsis&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> low blood pressure&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> non-white race<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and age more than 12 years<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have been identified as risk factors for an increased mean length of stay&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; the use of granulocyte-colony stimulating factor &#40;G-CSF&#41; has been associated with a significantly lower mean length of stay &#40;1&#8211;2 days&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> In the paediatric population&#44; current guidelines recommend using G-CSF for primary or secondary prophylaxis or for treatment only in patients classified as high-risk&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition&#44; postchemotherapy febrile neutropenia episodes place a considerable financial burden on the national health system<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;13</span></a> in terms of both direct and indirect costs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In light of the above&#44; identifying the factors associated to prolonged lengths of stay is of the essence&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main objective of our study was to identify the risk factors associated with an increased length of stay in episodes of febrile neutropenia associated with chemotherapy in our hospital over a 3-year period&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The secondary objective was to describe the distribution of microbiological isolates and foci of infection in our patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">We conducted a retrospective and prospective observational study &#40;01&#47;07&#47;2015&#8211;31&#47;12&#47;2018&#41; of the episodes of febrile neutropenia associated to chemotherapy in paediatric patients managed in a tertiary care hospital&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The inclusion criteria were age 0&#8211;18 years&#44; delivery of chemotherapy by the Department of Paediatric Oncology and Haematology&#44; an axillary temperature of 38<span class="elsevierStyleHsp" style=""></span>&#176;C or higher and an absolute neutrophil count of 500&#47;mm<span class="elsevierStyleSup">3</span> or lower&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The exclusion criteria were age more than 18 years&#44; neutropenia of any aetiology unrelated to chemotherapy&#44; an absolute neutrophil count of more than 500<span class="elsevierStyleHsp" style=""></span>cells&#47;mm<span class="elsevierStyleSup">3</span> &#40;moderate or mild neutropenia not requiring hospital admission&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We collected data for the following variables&#58; age&#44; sex&#44; weight percentile&#44; body temperature &#40;&#176;C&#41;&#44; pathogen isolation &#40;blood culture&#44; urine culture&#44; stool culture&#44; throat culture&#44; rapid respiratory syncytial virus &#91;RSV&#93; and influenza A and B tests &#91;Alere BinaxNOW &#174; RSV and BinaxNOW &#174; Influenza A &#38; B&#93;&#41;&#44; administration or lack of administration of antibiotic and&#47;or antifungal prophylaxis&#44; haemoglobin concentration &#40;g&#47;dL&#41;&#44; platelet count &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; neutrophil count &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; lymphocyte count &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; monocyte count &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; C-reactive protein &#40;CRP&#41; &#40;mg&#47;L&#41; and procalcitonin &#40;PCT&#41; &#40;ng&#47;ml&#41; levels at admission&#44; days with neutropenia with a neutrophil count of less than 500&#47;mm<span class="elsevierStyleSup">3</span>&#44; focus of infection and length of stay in days&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We calculated the Pearson <span class="elsevierStyleItalic">r</span> to analyse the correlation between the length of stay and the weight percentile&#44; temperature&#44; haemoglobin concentration&#44; platelet&#44; neutrophil&#44; lymphocyte and monocyte counts&#44; levels of CPR and PCT and days with neutropenia with less than 500 neutrophils&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We also made analyses by subgroups using the Student <span class="elsevierStyleItalic">t</span> test&#44; comparing the mean length of stay of patients based on whether they had a neutrophil count of 100&#47;mm<span class="elsevierStyleSup">3</span> or less at admission&#44; a CPR level of 90<span class="elsevierStyleHsp" style=""></span>mg&#47;L or greater&#44; a PCT level of 1<span class="elsevierStyleHsp" style=""></span>ng&#47;mL or greater&#44; microbial isolation&#44; the focus of infection&#44; and use antibiotic and&#47;or antifungal prophylaxis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We used the personal data of participants in adherence with current legislation and safeguarded patient confidentiality&#46; No report or publication will therefore include any identifiable data&#46; The study was approved by the Clinical Research Ethics Committee&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The analysis was carried out with the statistical software SPSS version 23&#46; We defined statistical significance as a <span class="elsevierStyleItalic">p-</span>value of less than 0&#46;05 in any of the tests&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">In the period under study&#44; 69 patients met the inclusion criteria&#44; corresponding to a total of 101 episodes of postchemotherapy febrile neutropenia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The mean length of stay was 7&#46;38 days &#40;median&#44; 6 days&#41;&#46; The remaining median values were age 6 years&#44; weight on the 25th percentile&#44; fever of 38&#46;2<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; haemoglobin concentration of 8&#46;9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; platelet count of 54 000&#47;mm<span class="elsevierStyleSup">3</span>&#44; neutrophil count of 100&#47;mm<span class="elsevierStyleSup">3</span>&#44; lymphocyte count of 200&#47;mm<span class="elsevierStyleSup">3</span>&#44; monocyte count of 0&#47;mm<span class="elsevierStyleSup">3</span>&#44; CRP level of 46<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; PCT level of 0&#46;26<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44; 3 days with neutrophil count of less than 500&#47;mm<span class="elsevierStyleSup">3</span>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A microbial isolate was obtained in 45 episodes &#40;44&#46;6&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents the distribution of the foci of infection&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> presents the distribution of patients by type of tumour&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">We analysed the correlation of the length of stay to the rest of the quantitative variables under study&#44; and found a statistically significant correlation with the haemoglobin concentration &#40;&#8211;0&#46;307&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#44; the platelet count &#40;&#8211;0&#46;215&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>&#46;031&#41; and the lymphocyte count &#40;&#8211;0&#46;205&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>&#46;04&#41; at admission and the CPR level &#40;0&#46;204&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;&#44; results that are represented in <a class="elsevierStyleCrossRef" href="#fig0015">Figs&#46; 3</a> to <a class="elsevierStyleCrossRef" href="#fig0030">6</a>&#46; The correlations with the remaining variables were not statistically significant&#44; although the <span class="elsevierStyleItalic">p-</span>value corresponding to the neutrophil count at admission neared the threshold of significance &#40;&#8211;0&#46;191&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>&#46;056&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The remaining results of the analysis can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The mean stay reported in the literature ranges between 5 and 19&#46;7 days per episode&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9&#44;13&#44;14</span></a> depending on the case series&#46; The mean found in our sample fell within this range and was consistent with most published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9&#44;13&#44;14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In our sample&#44; the percentage of cases in which a pathogen was isolated was slightly greater compared to the literature&#44; in which reported proportions range from 10&#37; to 40&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;15&#44;16</span></a> This may be explained in part by viruses causing a substantial percentage of infections in febrile neutropenia episodes &#40;44&#8211;57&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and thus in our hospital we perform rapid tests for RSV and influenza during the epidemic season&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">On the other hand&#44; the distribution of cases by focus of infection was consistent with the literature<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#58; 32&#37; of episodes are of fever without a focus &#40;35&#37; in our sample&#41;&#44; and 20&#37; are episodes of bacteraemia &#40;12&#37; cases of invasive bacterial infection and 6&#37; cases of central catheter-related infection&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">We ought to highlight that the length of stay for episodes in which a causative pathogen was identified was 4 days longer &#40;a statistically significant difference&#41;&#46; This could be due to a greater severity of disease or to an intent to ensure completion of the duration of antibiotherapy required by each infection&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">When it came to the factors associated with an increased length of stay&#44; our results suggested a negative correlation with the haemoglobin concentration&#44; the platelet count and the lymphocyte count&#44; factors that had not been previously described&#46; We also found a positive correlation between the mean length of stay and the CPR levels at admission&#44; which seems logical and is consistent with the previous literature&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In addition&#44; we found a statistically significant association between the PCT and neutrophil values at admission on one hand and an increased length of stay on the other&#46; These factors have been previously described in the literature as predictors of poor outcomes&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> but not of prolonged lengths of stay&#46; These results agree with previous findings&#44; as episodes with poor outcomes may be associated with longer lengths of stay&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Although we did not find a statistically significant association between the neutrophil count at admission and the length of stay&#44; the <span class="elsevierStyleItalic">p-</span>value neared the threshold of significance&#44; so it is likely that this association would be significant if analysed in a larger sample&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">One of the main limitations of our study was the small sample size&#46; In addition&#44; in most patients we were unable to determine whether they received G-CSF&#44; which has been associated with shorter mean lengths of stay and may have had an impact on the results&#46; Another limitation is that the time elapsed to administration of the first dose of antibiotherapy in the emergency department was not recorded&#44; although the previous literature suggests that this variable is not associated with length of stay&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Identifying these factors as new indicators of an increased length of stay may help guide clinical decision-making in these episodes and optimise the use of available resources&#44; as well as plan the management of patients to try to minimise the impact to their quality of life&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Infections are a significant cause of morbidity and mortality in cancer patients &#40;mortality is estimated at around 3&#37;&#41;&#46; Febrile neutropenia often leads to the hospitalisation of cancer patients&#44; increasing the risk of nosocomial infection&#44; as well as health costs due to the hospital admission&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An ambispective &#40;01 July 2015&#8211;12 July 2018&#41; observational study was conducted on all episodes of chemotherapy-induced febrile neutropenia in a paediatric population&#46; A record was made of age&#44; gender&#44; weight percentile &#40;WHO&#41;&#44; length of hospital stay &#40;days&#41;&#44; temperature &#40;&#176;C&#41;&#44; microbial isolation&#44; infectious source&#44; antibiotic or antifungal prophylaxis&#44; haemoglobin &#40;g&#47;dl&#41;&#44; platelets &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; neutrophils &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; lymphocytes &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; monocytes &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; CRP &#40;mg&#47;L&#41; and procalcitonin &#40;PCT&#41; &#40;ng&#47;ml&#41; on admission&#44; and days with neutropenia<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>500&#47;mm<span class="elsevierStyleSup">3</span>&#46; Statistical analysis was performed using the SPSSv&#46;23 program&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The study included 69 patients&#44; and 101 episodes were recorded&#46; The mean stay was 7&#46;43 days &#40;median 6 days&#41;&#46; Microbial isolation was found in 44&#46;6&#37; of the episodes&#44; with no infectious source identified in 36&#37; of them&#46; An inverse correlation was found between haemoglobin&#44; platelets&#44; and lymphocytes on admission and the hospital stay &#40;&#8722;0&#46;356&#58; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; &#8722;0&#46;216&#58; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;042&#44; and &#8722;0&#46;216&#58; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;042&#44; respectively&#41;&#46; The mean stay was greater if there was a CRP &#62;90<span class="elsevierStyleHsp" style=""></span>mg&#47;L &#40;10&#46;94 vs&#46; 6&#46;66 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#44; if PCT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;16&#46;50 vs&#46; 6&#46;77 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0002&#41;&#44; if &#8804;100 neutrophils &#40;8&#46;27 vs&#46; 5&#46;04 days <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;039&#41; on admission&#44; and if there was microbe isolation &#40;9&#46;54 vs&#46; 5&#46;78 days <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The relationship between haemoglobin&#44; platelets&#44; and lymphocytes on admission and the mean stay is inversely proportional&#46; In addition&#44; those patients with &#8804;100 neutrophils&#44; CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; and PCT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml on admission had a longer hospital stay&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Las infecciones son una causa importante de morbimortalidad en los pacientes con c&#225;ncer &#40;mortalidad estimada en 3&#37;&#41;&#46; La neutropenia febril conlleva con frecuencia el ingreso hospitalario de los pacientes oncol&#243;gicos&#44; incrementando el riesgo de infecci&#243;n nosocomial as&#237; como los costes sanitarios por ingresos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional ambispectivo &#40;01&#47;07&#47;2015&#8211;31&#47;12&#47;2018&#41; de los episodios de neutropenia febril post-quimioterapia en poblaci&#243;n pedi&#225;trica&#46; Se recogieron edad&#44; sexo&#44; percentil de peso&#40;OMS&#41;&#44; estancia hospitalaria&#40;d&#237;as&#41;&#44; temperature &#40;&#176;C&#41;&#44; aislamiento de germen&#44; foco infeccioso&#44; profilaxis o no antibi&#243;tica y antif&#250;ngica&#44; cifras de hemoglobina&#40;g&#47;dl&#41;&#44; plaquetas&#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; neutr&#243;filos&#40;&#47;mm<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#41;&#44; linfocitos&#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; monocitos&#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; prote&#237;na C reactiva &#40;PCR&#41;&#40;mg&#47;L&#41; y procalcitonina&#40;PCT&#41;&#40;ng&#47;ml&#41; al ingreso y d&#237;as con neutropenia &#60;500&#47;mm<span class="elsevierStyleSup">3</span>&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSSv&#46;23&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">De 69 pacientes&#44; se registraron 101 episodios&#46; La estancia media fue de 7&#44;43 d&#237;as &#40;mediana 6 d&#237;as&#41;&#46; Se aisl&#243; germen en un 44&#46;6&#37; de los episodios&#44; no identific&#225;ndose foco infeccioso en un 36&#37; de los mismos&#46; Se hall&#243; correlaci&#243;n inversa entre hemoglobina&#44; plaquetas y linfocitos al ingreso con la estancia hospitalaria &#40;&#8722;0&#44;356 &#40;p0&#44;001&#41;&#59; &#8722;0&#44;216 &#40;p0&#44;042&#41; y &#8722;0&#44;216&#40;p0&#44;042&#41; respectivamente&#41;&#46; La estancia media fue mayor si al ingreso presentaron PCR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#40;10&#44;94 vs&#46;6&#44;66 d&#237;as p0&#44;017&#41;&#44; si PCT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;16&#44;50 vs&#46;6&#44;77 d&#237;as p0&#44;0002&#41;&#44; si &#8804;100neutr&#243;filos&#40;8&#44;27vs&#46;5&#44;04 d&#237;as p0&#44;039&#41; y si hubo aislamiento microbiol&#243;gico &#40;9&#44;54vs&#46;5&#44;78 d&#237;as p0&#44;006&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La relaci&#243;n entre hemoglobina&#44; plaquetas y linfocitos al ingreso con la estancia media es inversamente proporcional&#46; Adem&#225;s&#44; aquellos pacientes con &#8804;100 neutr&#243;filos al ingreso&#44; PCR&#62;90<span class="elsevierStyleHsp" style=""></span>mg&#47;L y PCT&#62;1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml presentaron mayor estancia media&#46; Estos factores podr&#237;an ser importantes en el manejo de la neutropenia febril en el paciente con c&#225;ncer infantil&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez-Heras &#205;&#44; Raynero-Mellado RC&#44; D&#237;az-Merch&#225;n R&#44; Dom&#237;nguez-Pinilla N&#46; Neutropenia febril posquimioterapia&#46; Estancia hospitalaria y experiencia en nuestro medio&#46; An Pediatr &#40;Barc&#41;&#46; 2020&#59;92&#58;141&#8211;146&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;039</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PCT &#40;ng&#47;mL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;0002</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;004</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;165</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antifungal prophylaxis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;938</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Type of tumour</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="middle">&#46;073</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Solid tumour&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                      "titulo" => "Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia&#58; a report from the Children&#8217;s Oncology Group"
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                      "doi" => "10.1002/pbc.20366"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Treat Rev"
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "T&#46;J&#46; Smith"
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                            2 => "G&#46;H&#46; Lyman"
                            3 => "K&#46;R&#46; Carson"
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                  "host" => array:1 [
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                        "tituloSerie" => "J Clin Oncol Off J Am Soc Clin Oncol"
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2019.05.008

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2024 June	108	33	141
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2024 March	79	32	111
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2024 January	56	20	76
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2023 May	83	27	110
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2023 March	86	30	116
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2022 December	98	27	125
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2022 October	86	44	130
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2022 August	87	45	132
2022 July	65	41	106
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2022 April	52	31	83
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2021 December	69	47	116
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2021 April	313	91	404
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