Use of antimicrobials in the treatment of febrile neutropenia in pediatric patients in a teaching hospital
DOI:
https://doi.org/10.30968/rbfhss.2023.144.0903Abstract
Objectives: to assess the use of antimicrobials for the treatment of febrile neutropenia in pediatric patients Methods: a cross-sectional, retrospective and observational study carried out in the pediatric units of a large teaching hospital with high and medium complexity. All patients aged between 28 days and 17 years old, 11 months and 29 days old, who had febrile neutropenia and started a venous antimicrobials, were included in the study. Data were collected using available systems and compared with the sectoral clinical protocol. Results: 40 patients were included in the study, most of them male and with a median age of 8 years old. There were 70 episodes of neutropenia, and 57% were in disagreement with the protocol. The most common errors were the use of antimicrobials for longer than necessary, followed by de-escalation not performed after the culture result was available and antimicrobial incorrectly replaced. Considering the antimicrobials, the most prevalent was cefepime, and considering the antifungals, it was micafungin. Prescribed doses were in accordance with protocol, except for eight polymyxin loading dose prescriptions and one teicoplanin loading dose. Blood cultures were positive in 25.7% of cases and the most common microorganisms were Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis. Conclusion: there were high rates of non-compliance in the use of antimicrobials for the treatment of febrile neutropenia with the sectoral clinical protocol, despite the fact that most prescriptions follow what is recommended when it comes to treatment initiation. It is essential to adapt the prescriptions to the institutional protocol so that the patient receives an effective and safe treatment, avoiding the occurrence of bacterial resistance due to the inappropriate use of medicines.
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