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

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    Author
    McMullan, BJ; Haeusler, GM; Hall, L; Cooley, L; Stewardson, AJ; Blyth, CC; Jones, CA; Konecny, P; Babl, FE; Mechinaud, F; ...
    Date
    2020-09-16
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Babl, Franz; Thursky, Karin; McMullan, Brendan; Haeusler, Gabrielle; Jones, Cheryl
    Affiliation
    Paediatrics (RCH)
    Medicine and Radiology

    Sir Peter MacCallum Department of Oncology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    McMullan, B. J., Haeusler, G. M., Hall, L., Cooley, L., Stewardson, A. J., Blyth, C. C., Jones, C. A., Konecny, P., Babl, F. E., Mechinaud, F. & Thursky, K. (2020). Aminoglycoside use in paediatric febrile neutropenia - Outcomes from a nationwide prospective cohort study. PLOS ONE, 15 (9), https://doi.org/10.1371/journal.pone.0238787.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/251594
    DOI
    10.1371/journal.pone.0238787
    NHMRC Grant code
    NHMRC/1104527
    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.

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