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dc.contributor.authorMcMullan, BJ
dc.contributor.authorHaeusler, GM
dc.contributor.authorHall, L
dc.contributor.authorCooley, L
dc.contributor.authorStewardson, AJ
dc.contributor.authorBlyth, CC
dc.contributor.authorJones, CA
dc.contributor.authorKonecny, P
dc.contributor.authorBabl, FE
dc.contributor.authorMechinaud, F
dc.contributor.authorThursky, K
dc.date.accessioned2020-11-17T03:45:59Z
dc.date.available2020-11-17T03:45:59Z
dc.date.issued2020-09-16
dc.identifierpii: PONE-D-20-21064
dc.identifier.citationMcMullan, 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.
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/11343/251594
dc.description.abstractAminoglycosides 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.
dc.languageEnglish
dc.publisherPUBLIC LIBRARY SCIENCE
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleAminoglycoside use in paediatric febrile neutropenia - Outcomes from a nationwide prospective cohort study
dc.typeJournal Article
dc.identifier.doi10.1371/journal.pone.0238787
melbourne.affiliation.departmentSir Peter MacCallum Department of Oncology
melbourne.affiliation.departmentPaediatrics (RCH)
melbourne.affiliation.departmentInfectious Diseases
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titlePLoS One
melbourne.source.volume15
melbourne.source.issue9
melbourne.identifier.nhmrc1104527
dc.rights.licenseCC BY
melbourne.elementsid1465688
melbourne.contributor.authorBabl, Franz
melbourne.contributor.authorThursky, Karin
melbourne.contributor.authorMcMullan, Brendan
melbourne.contributor.authorHaeusler, Gabrielle
melbourne.contributor.authorJones, Cheryl
dc.identifier.eissn1932-6203
melbourne.identifier.fundernameidNHMRC, 1104527
melbourne.accessrightsOpen Access


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