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Aminoglycoside use in paediatric febrile neutropenia - Outcomes from a nationwide prospective cohort study

Citation

McMullan, BJ and Haeusler, GM and Hall, L and Cooley, L and Stewardson, AJ and Blyth, CC and Jones, CA and Konecny, P and Babl, FE and Mechinaud, F and Thursky, K, Australian PICNICC study group and the PREDICT network, Aminoglycoside use in paediatric febrile neutropenia - Outcomes from a nationwide prospective cohort study, PLoS One, 15, (9) Article e0238787. ISSN 1932-6203 (2020) [Refereed Article]


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DOI: doi:10.1371/journal.pone.0238787

Abstract

Aminoglycosides are commonly prescribed to children with febrile neutropenia (FN) but their impact on clinical outcomes is uncertain and extent of guideline compliance is unknown. We aimed to review aminoglycoside prescription and additional antibiotic prescribing, guideline compliance and outcomes for children with FN. We analysed data from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) prospective multicentre cohort study, in children <18 years with FN between November 2016 and January 2018. Impact of aminoglycoside use in the first 12 hours of FN on composite unfavourable outcome of death, ICU admission, relapse of infection or late-onset sepsis was assessed using multivariable Cox regression. The study was conducted in Australia where antimicrobial resistance among gram negative organisms is relatively low. Data from 858 episodes of FN in 462 children from 8 centres were assessed, median age 5.8 years (IQR 3.5-10.8 years). Early empiric aminoglycosides were prescribed in 255 episodes (29.7%). Guideline non-compliance was common: in 46% (184/400) of eligible episodes, patients did not receive aminoglycosides, while aminoglycosides were prescribed in 9% (39/458) of guideline-ineligible episodes. Adjusted hazard of the composite unfavourable outcome was 3.81 times higher among patients prescribed empiric aminoglycosides than among those who weren't (95% confidence interval, 1.89-7.67), with no increased risk of unfavourable outcome in eligible patients who did not receive aminoglycosides. In a large paediatric FN cohort, aminoglycoside prescription was common and was often non-compliant with guidelines. There was no evidence for improved outcome with aminoglycosides, even in those who met guideline criteria, within a low-resistance setting. Empiric aminoglycoside prescription for children with FN requires urgent review in guidelines and in national practice.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Paediatrics
Research Field:Infant and child health
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Neonatal and child health
UTAS Author:Cooley, L (Dr Louise Cooley)
ID Code:151602
Year Published:2020
Web of Science® Times Cited:1
Deposited By:Medicine
Deposited On:2022-08-02
Last Modified:2022-08-02
Downloads:0

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