Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Urinary tract infections in pediatric oncology patients with febrile neutropenia

호중구 감소성 발열을 보이는 소아 암 환자에서의 요로감염에 대한 연구

  • Suh, Kyoo Hyun (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Park, Sun Young (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Kim, Sae Yoon (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Lee, Jae Min (Department of Pediatrics, College of Medicine, Yeungnam University)
  • 서규현 (영남대학교 의과대학 소아과학교실) ;
  • 박선영 (영남대학교 의과대학 소아과학교실) ;
  • 김세윤 (영남대학교 의과대학 소아과학교실) ;
  • 이재민 (영남대학교 의과대학 소아과학교실)
  • Received : 2016.08.24
  • Accepted : 2016.10.28
  • Published : 2016.11.18
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Abstract

Background: Neutropenic fever is one of the most common and potentially severe complications of chemotherapy in pediatric oncology patients, while urinary tract infection (UTI) is one of the most prevalent bacterial infections in these patients. Therefore, this study was conducted to investigate features of UTI with neutropenic fever in pediatric oncology patients. Methods: We retrospectively reviewed and analyzed the medical records, laboratory results and image findings of cases of neutropenic fever in the Department of Pediatrics of Yeungnam University Medical Center, South Korea between November 2013 and May 2015. Episodes were divided into two groups, UTI vs. non-UTI group according to the results of urine culture. The results were then compared between groups. The analysis was performed using IBM SPSS 23.0. A p-value <0.05 was considered to indicate a significant difference between groups. Results: Overall, 112 episodes of neutropenic fever were analyzed, among which 22 episodes (19.6%) showed organisms on urine culture and were classified as UTI. The remaining 90 episodes were classified as non-UTI. Only four episodes (18.2%) of the UTI group showed pyuria on urine analysis. In the UTI group, 76.5% were sensitive to the first line antibiotics and showed higher clinical response than the non-UTI group. Among hematologic malignancy patients, the UTI group revealed higher serum ${\beta}2$-microglobulin levels than the non-UTI group ($1.56{\pm}0.43mg/L$ vs. $1.2{\pm}0.43mg/L$, p<0.028). Conclusion: UTI in pediatric neutropenic fever responds well to antibiotics. Hematologic malignancy cases with UTI reveal increased serum ${\beta}2$-microglobulin level. These results will be helpful to early phase diagnosis of UTI.

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References

  1. Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 2012;30:4427-38. https://doi.org/10.1200/JCO.2012.42.7161
  2. Miedema KG, Tissing WJ, Abbink FC, Ball LM, Michiels EM, van Vliet MJ, et al. Risk-adapted approach for fever and neutropenia in paediatric cancer patients--a national multicentre study. Eur J Cancer 2016;53:16-24. https://doi.org/10.1016/j.ejca.2015.10.065
  3. Tezcan G, Kupesiz A, Ozturk F, Ogunc D, Gultekin M, Yesilipek A, et al. Episodes of fever and neutropenia in children with cancer in a tertiary care medical center in Turkey. Pediatr Hematol Oncol 2006;23:217-29. https://doi.org/10.1080/08880010500506719
  4. Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol 2008;25:385-92. https://doi.org/10.1080/08880010802106564
  5. Lohr JA, Portilla MG, Geuder TG, Dunn ML, Dudley SM. Making a presumptive diagnosis of urinary tract infection by using a urinalysis performed in an on-site laboratory. J Pediatr 1993;122:22-5. https://doi.org/10.1016/S0022-3476(05)83481-X
  6. Urabe A. Clinical features of the neutropenic host: definitions and initial evaluation. Clin Infect Dis 2004;39(Suppl 1):S53-5. https://doi.org/10.1086/383055
  7. Klaassen IL, de Haas V, van Wijk JA, Kaspers GJ, Bijlsma M, Bokenkamp A. Pyuria is absent during urinary tract infections in neutropenic patients. Pediatr Blood Cancer 2011;56:868-70. https://doi.org/10.1002/pbc.22799
  8. Sandoval C, Sinaki B, Weiss R, Munoz J, Ozkaynak MF, Tugal O, et al. Urinary tract infections in pediatric oncology patients with fever and neutropenia. Pediatr Hematol Oncol 2012;29:68-72. https://doi.org/10.3109/08880018.2011.617809
  9. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-51. https://doi.org/10.1086/339215
  10. Santolaya ME, Alvarez AM, Aviles CL, Becker A, Cofre J, Enriquez N, et al. Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia. Clin Infect Dis 2002;35:678-83. https://doi.org/10.1086/342064
  11. Wald E. Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 2004;16:85-8. https://doi.org/10.1097/00008480-200402000-00016
  12. Choi L, Cho SE, Yim HE, Yoo KH, Hong YS, Lee JW. Clinical significance of pyuria in pediatric patients with febrile urinary tract infection. J Korean Soc Pediatr Nephrol 2011;15:66-75. Korean.
  13. Mulinde J, Joshi M. The diagnostic and therapeutic approach to lower respiratory tract infections in the neutropenic patient. J Antimicrob Chemother 1998;41(Suppl D):51-5.
  14. Mori R, Yonemoto N, Fitzgerald A, Tullus K, Verrier-Jones K, Lakhanpaul M. Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy. Acta Paediatr 2010;99:581-4. https://doi.org/10.1111/j.1651-2227.2009.01644.x
  15. Savory DJ. Reference ranges for serum creatinine in infants, children and adolescents. Ann Clin Biochem 1990;27:99-101. https://doi.org/10.1177/000456329002700201
  16. Clark LC Jr, Thompson HL, Beck EI, Jacobson W. Excretion of creatine and creatinine by children. AMA Am J Dis Child 1951;81:774-83.
  17. Ahlstrom A, Tallgren M, Peltonen S, Pettila V. Evolution and predictive power of serum cystatin C in acute renal failure. Clin Nephrol 2004;62:344-50. https://doi.org/10.5414/CNP62344
  18. Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Dragun D, et al. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study. Crit Care Med 2009;37:553-60. https://doi.org/10.1097/CCM.0b013e318195846e
  19. Herrero-Morin JD, Malaga S, Fernandez N, Rey C, Dieguez MA, Solis G, et al. Cystatin C and beta2-microglobulin: markers of glomerular filtration in critically ill children. Crit Care 2007;11:R59. https://doi.org/10.1186/cc5923
  20. Yim HE, Yim H, Bae ES, Woo SU, Yoo KH. Predictive value of urinary and serum biomarkers in young children with febrile urinary tract infections. Pediatr Nephrol 2014;29:2181-9. https://doi.org/10.1007/s00467-014-2845-0
  21. Sim JH, Yim HE, Yoo KH. Correlation between serum cystatin c levels and clinical parameters in children with urinary tract infections. J Korean Soc Pediatr Nephrol 2014;18:85-91. Korean. https://doi.org/10.3339/jkspn.2014.18.2.85
  22. Ikezumi Y, Honda M, Matsuyama T, Ishikura K, Hataya H, Yata N, et al. Establishment of a normal reference value for serum ${\beta}2$ microglobulin in Japanese children: reevaluation of its clinical usefulness. Clin Exp Nephrol 2013;17:99-105. https://doi.org/10.1007/s10157-012-0658-7
  23. Jo YJ, Lee EJ, Choi KM, Eun YM, Yoo HJ, Kim CH, et al. Causative organisms of community acquired urinary tract infection and their antibiotic susceptibility at a secondary hospital in Korea. Korean J Pediatr Infect Dis 2010;17:30-5. Korean. https://doi.org/10.14776/kjpid.2010.17.1.30
  24. Johnson JR, Vincent LM, Wang K, Roberts PL, Stamm WE. Renal ultrasonographic correlates of acute pyelonephritis. Clin Infect Dis 1992;14:15-22. https://doi.org/10.1093/clinids/14.1.15
  25. Choi JY, Cho JH, Park YH. Power Doppler sonography for the upper urinary tract infection in children. Yeungnam Univ J Med 2007;24:179-85. Korean. https://doi.org/10.12701/yujm.2007.24.2.179