Febrile neutropenia in children

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Fever and Neutropenia in the Child with Cancer
(Amended July, 2006)
1. Background
The etiology of fever in most children with cancer hospitalized for febrile neutropenia is
unknown. A localized bacterial infection or bacteremia has been demonstrated in 10-40%
of patients. In a study from Dallas on 104 febrile neutropenic children with cancer1
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children (25%) had clinical infections (i.e. pharyngitis, bronchitis, sinusitis, etc) and 10
(11%) had proven bacteremias. Seven of the 11 isolates (one patient had 2 pathogens)
were gram-positive and 4 were gram -negative bacteria.
The initial empirical treatment of the child with fever and neutropenia should be
according to their clinical risk category ( i.e. low-risk vs. high-risk). The traditional
approach of using a combination of two or three antibiotics is still appropriate for the
high-risk patients. Monotherapy with third- or fourth-generation cephalosporins (i.e.
ceftazidime or cefepime, respectively) or carbapenems (i.e. imipenem, meropenem) is
considered to be adequate initial empirical treatment for the non-high risk,
"uncomplicated" patients 2,3
. Ceftazidime has excellent gram-negative coverage but
limited or no activity against most gram-positive organisms. Cefepime and carbapenems
have activity against gram negative bacteria, as well as most strains of pneumococci and
Streptococcus viridans. Carbapenems also have activity against anaerobic pathogens. Of
the two-carbapenem antibiotics, meropenem is preferred over imipenem because of its
fewer side effects, especially G.I. (i.e less nausea or vomiting) and CNS toxicity (i.e. no
seizures).
A randomized study1 of cefepime versus ceftazidime in children with febrile neutropenia
showed a response rate of 74 % and 70 %, respectively, among 68 evaluable patients.
Addition of vancomycin and other antibiotics was required in 12 % of the cefepime-
treated patients and 14 % of the ceftazidime-treated patients. Of note is that 6 of the 8
patients with staph coagulase-negative isolates were randomized to treatment with
ceftazidime.
Among the risk factors in febrile neutropenic patients, oral mucositis and prior treatment
with high-dose Ara-C are risk factors for viridans streptococci bacteremia4
. Clinically,
this often manifests with very high fevers ( i.e. temperature > 40 ° C) and tachypnea (?
ARDS).
Microorganisms isolated from blood cultures of febrile neutropenic patients at Egleston
and Scottish Rite hospitals (October 2001-October 2002) are shown in Appendices II and
III, and sensitivities of these organisms in Appendix IV.

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2 LOW-RISK PATIENTS
2.1 Definition of Fever and Neutropenia
2.1.1 Fever: single oral temperature of 38.5 °C, or two temperature readings of 38
°C, one hour apart.
2.1.2 Neutropenia: Absolute neutrophil count (ANC) of less than 500/uL or
<1000/uL and falling.
2.2 Definition of Low-Risk Patients
2.2.1 Patient is not hospitalized at the onset of fever.
2.2.2 Patient has a solid tumor (including Hodgkins lymphoma), ALL in
remission (Exception: high-risk B-ALL in consolidation), and NHL in
remission.
2.2.3 Patient with neutropenia for less than 7 days.
2.2.4 Patient does not have comorbidity such as hypotension, tachypnea, or
organ failure.
2.2.4 Patient does not have chills, pneumonia, cellulitis, (CVL) tunnel infection,
or a portacath pocket infection.
2.2.5 Patient does not have severe GI mucositis
2.2.6 Patient does not have abdominal pain, perianal tenderness, or bloody
diarrhea.
2.2.7 Patient has a temperature < 39.5 °C.
2.2.8 Patient with neutropenia anticipated to last less than 10 days.
2.3 Clinical Guidelines
2.3.1 Note associated symptoms: chills, abdominal pain, tachypnea, cough,
height of temperature; history of allergy to antibiotics
2.3.2 Physical examination: Note hydration status, capillary refill; check for
tenderness, erythema, and/or increased warmth of overlying skin over
Broviac/Hickman line, portacath, peripheral IV lines, BM, and LP sites.
2.3.3 Pulse oximetry if patient has respiratory symptoms.
2.4 Laboratory Guidelines
2.4.1 CBC with differential, BUN, creatinine, electrolytes, ALT, bilirubin, total
protein and albumin.
2.4.2 Blood cultures (4 cc for aerobic and 4 cc for anaerobic cultures) from

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portacath or each lumen of the Broviac/Hickman lines.
2.4.3 If there is no central venous line device or unable to draw from it, obtain a
peripheral blood culture (4 cc for each type of culture).
2.4.4 Peak and trough vancomycin and aminoglycoside levels around 3rd
dose
(if continuing with vancomycin is anticipated)
2.4.5 If clinically indicated: viral respiratory panel (by direct fluorescent
antibody, DFA) or respiratory viral cultures for adenovirus, influenza A and B,
parainfluenza types 1,2, and 3, adenovirus, and RSV; or swab of oral/perioral
lesions for HSV DFA and/or culture, throat culture, and urine culture.
2.4.6 Spinal tap to rule in/out meningitis, if clinically indicated.
2.5 Imaging Studies
2.5.1 Chest-x-ray: If clinically indicated, i.e. patient has cough, tachypnea, or
oxygen requirement.
2.6 Treatment Guidelines
2.6.1 Supportive Measures:
2.6.1.1 IV fluids 1 ½ maintenance. If patient has poor capillary refill and/or
hypotension, administer a normal saline (NS) bolus, i.e. 20 cc/kg. Repeat
NS bolus x 2 if necessary to correct hypotension. If patient has
hypoalbuminemia ( i.e.< 3 g/dL) or anemia, consider use of 5 % albumin or
packed red cells (in addition to NS boluses x 2), respectively, for more
effective volume expansion.
2.6.1.2 If hypotension does not respond to adequate volume replacement,
patient isto be admitted to PICU.
2.6.1.3 Stop chemotherapy (i.e. oral 6-MP, MTX)
2.6.1.4 Continue with G-CSF
2.6.2 Initial Antibiotic Treatment
2.6.2.1 Consider treatment with
• Ceftazidime 50 mg/kg/dose (max. dose 2 gm) IV Q 8 h (*)

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(*)2.6.2.2 If patient has a history of severe allergic reaction (with
anaphylaxis or not) due to cephalosporins or penicillin, consider treatment
with:
• Tobramycin at conventional dose/schedules: 2.5 – 3
mg/kg/dose (max dose:140 mg) IV Q 8 hr, and
• Vancomycin 20 mg/kg/dose (maximum dose 1 gm) IV Q 8 hr*
(*) An alternative to using vancomycin would be Levofloxacin
(levoquin). Dose: If child is < 5 yr ( and > 6 mo) 10 mg/kg/dose Q
12 hr. If child is >5 yr of age 10 mg/kg/dose Q 24 hr.
2.6.3 Treatment Modifications:
2.6.3.1 Patient with positive blood cultures:
• Treat according to blood culture results and sensitivities. Consider
providing broad coverage until patient has become afebrile and has a
rising phagocyte count (i.e. > 200/uL, then continue with antibiotic (s)
as per sensitivity results.
• Do not use vancomycin if patient can be adequately treated with other
antibiotics.
2.6.3.2 If clinical deterioration occurs while patient is on ceftazidime
alone, discontinue ceftazidime and provide triple antibiotic treatment
with:
• Meropenem 20 mg/kg/dose (maximum dose 2 gm) IV Q 8 hr.
• Vancomycin 20 mg/kg/dose (maximum dose 1 gm) IV Q 8 hr, and
• Amikacin 7.5 – 10 mg/kg/dose IV Q 8 hr (maximum dose 500
mg/dose) IV Q 8 hr, or
2.6.3.3 Fever persisting beyond 72 hr of ceftazidime + other antibiotics but
patient is clinically stable:
• Rule out nonbacterial causes for fever
• Consider consulting with Infectious Disease (ID) service. Do not
add vancomycin for persistent fever unless there is clinical or
culture evidence of gram-positive infection.

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2.6.3.4 Fever persisting beyond 5 days of ceftazidime + other antibiotics:
2.6.3.4.1 Consider empirical antifungal-treatment with ambisome
(or abelcet) 3 mg/kg/day. If patient has renal insufficiency or is
allergic to these drugs, consider using:
2.6.3.4.2 If child is > 2 years of age, caspofungin (cancidas)* 70
mg/m2 IV as loading dose ( max 70 mg), then 50 mg/m2/day IV
(max 70 mg).
2.6.3.4.3 If child is < 2 years of age consider voriconazole** at 7
mg/kg/dose Q 12 hr IV.
(Note: For dose of voricanozale for children > 12 yr of age see
Chapter on Common Fungal Infectionsr)
2.6.3.4.4 Administer a normal saline bolus (i.e.10 - 20 cc/kg) prior to
infusion of ambisome or abelcet.
(*) Because the concomitant use of caspofungin and cyclosporine-A may
increase risk for caspofungin-induced hepatotoxicity, serum transaminases should
be monitored closely (at least twice a week). Caspofungin should be discontinued
if moderate to severe transaminitis occurs.
Consult clinical pharmacist for caspofungin dose adjustment if patient is on
cyclosporine, rifampin, phentoin, dexamethasone or carbamazepine.
(**)Consult with clinical pharmacist for dosing if patients is on phentoin,
cyclosporine, or tacrolimus.
See Antifungal Medications Table (Appendix II, Chapter Common Fungal
Infections) for drug interactions.
3 HIGH-RISK PATIENTS
3.1 Definition of Fever and Neutropenia
3.1.1 As defined on 2.1.1 and 2.1.2
3.2 Definition of High-Risk Patients
3.2.1 Patients with AML
3.2.2 Patients with ALL or NonHodgkins lymphoma on induction therapy

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3.2.3 Patients with very high-risk B-precursor ALL on consolidation therapy
and patients with relapsed B-ALL
3.2.4 Patients receiving high-dose Ara-C treatment
3.2.5 Patients with hypotension, chills, tachypnea, or organ failure
3.2.6 Patients with known history of MRSA colonization or infection
3.2.7 Patients with significant abdominal pain (i.e. not due to constipation),
perianal pain, bloody diarrhea
3.2.8 Patients with cellulitis, or clinically suspected CVL tunnel infection or
portacath pocket infection
3.2.9 Patients with fever > 40 °C
3.3.0 Patients with personal or family history of recurrent skin abscesses
3.3.1 Patients with suspected septic arthritis or osteomyelitis
3.3.0 Patients with known positive blood cultures for gram-positive organism
(final report pending)
3.3 Clinical Guidelines
3.3.1 History and Physical examination: note for presence of chills, abdominal
pain, watery or bloody stools; ill-appearance, location of abdominal pain,
check for peritoneal signs, check for infection/inflammation of perianal
area or CVL/ PAC sites.
3.4 Laboratory and Imaging Studies
3.4.1 CBC- diff, chemistries, blood cultures, vancomycin and aminoglycoside
levels as per section 2.4.
3.4.2 If patient is on amphotericin-B, serum potassium should be checked daily
prior to infusion ( r/o hypokalemia); BUN, creatinine and all electrolytes
should be checked twice a week.
3.4.3 If patient has diarrhea, stools for cultures, O & P, and clostridium
difficile.
3.4.4 If patient has vaginal discharge and gonorrhea or chlamydia are suspected,
nucleic acid by PCR for each organism should be obtained, from urine or
vaginal/uretral discharge.
3.4.5 As clinically indicated: chest-x-ray, KUB and ultrasound (US) of
abdomen (to rule out typhlitis), gallbladder US (to rule out gallstones,
cholecystitis); CT scan of abdomen (to rule out typhlitis, appendicitis,
ruptured viscus).
3.4.6 Spinal tap to rule out meningitis, if clinically indicated
3.5 Initial Antibiotic Treatment

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3.5.1 Clinically Stable Patients:
3.5.1.2 Ceftazidime* 50 mg/kg/dose (max. dose 2 gm) IV Q 8 hr, and
3.5.1.3 Vancomycin 20 mg/kg/dose (max. dose 1 gm) IV Q 8 hr
*For patients with history of severe allergic reactions to cephalosporin
and/or penicillins, consider use of :
3.5.1.4 Tobramycin instead of cefatazidime, 2.5 - 3.0 mg/kg/dose (max
dose: 140 mg) IV Q 8 hr.
3.5.1.5 For patients who become unstable and/or those who develop
symptoms/signs suggestive of intraabdominal infection ( i.e. enterocolitis,
typhlitis, etc) while receiving above double coverage, discontinue
ceftazidime (or tobramycin) and start meropenem and amikacin as per
3.5.2. Continue with triple antibiotics until culture results are available and
patient is clinically stable. When these two criteria are met, continuing
treatment with meropenem alone would probably suffice.
3.5.2 Clinically Unstable ( i.e.hypotension, tachypnea, chills) and/or Ill-looking
Patients**
3.5.2.1 Meropenem , as per 2.6.3.2,
3.5.2.2 Vancomycin, as per 3.5.1.3, and
3.5.2.3 Amikacin as per 2.6.3.2
3.6 Treatment Modifications
3.6.1 Patient with negative blood cultures for gram-positive organisms and
clinically stable: Stop Vancomycin.
3.6.2 Patients with positive blood cultures: Treat according to sensitivity data.
Provide broad coverage until patient becomes afebrile and absolute phagocyte
count is rising (i.e. APC >200/uL). Do not use vancomycin if patient can be
adequately treated with alternative antibiotics.
3.6.3 Patients with PAC/CVL cultures positive for Staph epidermidis or other
coagulase-negative species. Repeat blood cultures and do CRP. If repeat BC
is negative and CRP is low or normal and patient is clinically well, consider
possibility of contaminant. If repeat blood cultures confirm Staph

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epidermidis, consider continuing treatment with vancomycin or an alternative
antibiotic (i.e clindamycin)- according to sensitivities. Treat for a total of 10 days
from the first negative blood culture.
3.6.4 Patient with persistently positive PAC/CVL blood cultures for Staph
epidermidis or other coagulase-negative bacteria over 48 hr after the start of
vancomycin therapy, consider:
a) Venogram of PAC/CVL (or “linogram”). If a clot (intraluminal or at
tip of catheter) is demonstrated, treat with TPA according to protocol,
and repeat cultures after 24 hr of antibiotics post- TPA treatment.
b) If venogram (“linogram”) is negative consider adding rifampin (if
bacteria is sensitive to it) 10 mg/kg/dose IV Q 12 hr, to be infused
through the line.
3.6.4.1 Alternatively, remove infected catheter.
3.6.4.2 Consider consulting with ID
3.6.5 Patient with persistent fever over 72 hr but negative cultures:
3.6.5.1 Consider nonbacterial causes for fever.
3.6.5.2 Consult with ID
3.6.6 Patient with persistent positive blood cultures
3.6.6.1 Consult with ID
3.6.7 Patient with CVL tunnel or PAC pocket infection:
3.6.7.1 Remove central line device. Continue with appropriate
antibiotic(s).
3.6.7.2 Consult with ID.
3.6.8 Patient with CVL/PAC infection due to candida, Bacillus species,
vancomycin- resistant enterococci (VRE), Stenotrophomonas maltophilia,
atypical mycobacteria, Stomatoccocus mucilaginosa, Corynebacterium jeikeium,
Acinetobacter species:
3.6.8.1 Consider removal of central line device and placement of
temporary line for continuation of antibiotics.
3.6.8.2 Consult with ID.

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3.6.8.3 Continue with antibacterials or antifungals through temporary line
for 7 - 14 days.
3.6.8.4 For candida infections, see chapter on Common Fungal & Viral
Infections.
4. BLOOD AND MARROW TRANSPLANT PATIENTS
Consult BMT Guidelines
5. References
1. Mustafa M, Carlson L, Tkzewski I, et al. Comparative study of Cefepime versus
ceftazidime in the empiric treatment of Pediatric cancer patients with fever and
neutropenia, Ped Inf Dis J 2001; 20: 362-9
2. Alexander SW, Walsh TS, Freifeld AG, Pizzo PA. In Pizzo and Poplack, Pediatric
Infectious complications in Pediatric Cancer Patients. In Pizzo PA and Poplack DG
(Eds): Principles and Practice of Pediatric Oncology 2002: 1239-1283, 4th
Edition,
Lippincott Williams and Wilkins, Philadelphia.
3. Hughes WT, Amstrong D, Bodey GP, et al. 2002 Guidelines for the Use of
Antimicrobial Agne3ts in Neutropenic Patients with Cancer. Clin Infect Dis 2002; 34:
730-51
4. Weissman SJ, Scoopo FJ, Johnson GM, et al: Septicemia in Pediatric Oncology
Patients: The Significance of Viridans Streptococcal Infections. J Clin Oncol 1990; 8:
453-459.
5. Gassas A, Grant R, Richardson S, et al: Predictors of Viridans Streptococal Shock
Syndrome in Bacteremic Children With Cancer and Stem –Cell Transplant Recipients. J
Clin Oncol 2004; 22: 1222-1227.
5. Authors
Carlos S. Alvarado, M.D. Joseph Hilinski, M.D. Michele Gramling, PharmD
(Consultant Infectious Disease)
Tom Adamkiewicz, M.D Harry Keyserling, M.D. Terri Robinson, PNP
(Consultant Infectious Disease)
Bradley George, M.D Kelly Kercher, Pharm D James Rhodes, PharmD
Pamela Hoffmann, PharmD

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6. Appendices: 4
7. Approval By: Date
_________________________ __________
_________________________ __________
__________________________ __________

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Low Risk Patients
a) Not hospitalized at onset of fever.
b) Solid tumor (including Hodgkins), ALL/NHL in
remission (Exception: high-risk B-ALL in
consolidation)
c) Neutropenia < 7 days duration.
d) No hypotension, tachypnea, or organ failure.
e) No chills, pneumonia, cellulitis, no CVL
tunnel/PAC pocket infection
f) No severe GI mucositis
g)No abdominal pain, perianal tenderness, or bloody
diarrhea.
h) Temperature < 39.5 °C.
i) Anticipated duration neutropenia < 10 days.
Treatment: Clinically Stable
Ceftazidime*
50 mg/kg/dose (max 2 gm) IV Q 8 hr
Vancomycin
20 mg/kg/dose (max 1 gm) IV Q 8h.
* If allergic to cephalosporins/penicillin:
consider Tobramycin 2.5 - 3 mg/kg/dose (max 140 mg) IV
Q 8h instead of ceftazidime
APPENDIX I
Guidelines for Management of Fever
and Neutropenia in Oncology
Patients
High Risk Patients
a) a) Patients with AML
b) Patients with All or NHL on induction thera
c) Patients with very high risk B-ALL on consolidation
or relapsed B-ALL
d) Patients received high-dose Ara-C treatment
e e) Patients with hypotension, chills, tachypnea, or
organ failure
f) f) Patients with known history of MRSA colonization or
infection
g g) Patients with cellulitis, suspected CVL tunnel or PAC
pocket infection, suspected arthritis or osteomyelitis
h h) Patients with significant abdominal pain, perianal
pain, or bloody diarrhea.
i) Patients with temperature > 39.5 °C.
j) Patients with known positive blood cultures for
gram+ organism (final report pending)
Treatment: Clinically Unstable (hypotension, ill-looking)
Meropenem 20 mg/kg/dose (max 2 gm) IV Q 8 hr
Vancomycin 20 mg/kg/dose (max 1 gm) IV Q 8 hr
Amikacin 7.5 mg-10 mg/kg/dose (max 500 mg/dose) IV Q.
8 hr
Definition
Fever: oral temp > 38.5 C x 1 or 38 C x2 one hr apart
Neutropenia: ANC < 500 or 1000 and falling
Treatment:
Ceftazidime*
50 mg/kg/dose (max 2 gm) IV Q 8 hr
If clinical deterioration occurs, treat as Clinically Unstable
with meropenem (d/c CTZ), vancomycin, and amikacin
* If allergic to cephalosporins/penicillin:
consider Tobramycin 2.5 - 3 mg/kg/dose (max 140 mg)
IV Q 8h plus vancomycin 20 mg/kg/dose IV Q 8 hr

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APPENDIX II
CHOA-HEM/ONC/BMT SERVICES:
EGLESTON BLOOD CULTURES (10/01-10/02)
ORGANISMS COUNT PERCENT
COAGULASE-NEGATIVE STAPH 104 54
STAPH AUREUS 27 14
STREP,VIRIDANS 19 10
PSEUDOMONAS SP 8 4
ENTEROCOCCUS FAECALIS 7 4
ACINETOBACTER 4 2
ENTEROBACTER CLOACAE 4 2
E. COLI 4 2
SERRATIA MARCESCENS 3 2
STREP PNEUMONIAE 3 2
CITROBACTER FREUNDII 2 1
RHODOTORULA 1 1
STREP, GROUPB 1 1
CANDIDA KRUSEI 1 1
STENOTROPHOMONAS MALTOPHIA 1 1
PROTEUS MIRABILIS 1 1
CANDIDA PARAPSILOSIS 1 1
KLEBSIELLA PNEUMONIAE 1 1
BACILLUS SP 1 1
KLEBSIELLA SP 1 1

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APPENDIX III
CHOA-HEM/ONC/BMT SERVICES:
SCOTTISH RITE EGLESTON BLOOD CULTURES (10/01-10/02)
ORGANISMS COUNT PERCENT
COAGULASE-NEGATIVE STAPH 69 61
PSEUDOMONAS AERUGINOSA 9 8
STAPH AUREUS 9 8
E. COLI 5 4
ENTEROBACTER AGGLOMERANS 3 3
ENTEROCOCCUS FAECALIS 3 3
STREP PNEUMONIAE 3 3
MICROCOCCUS SP 3 3
STREP,VIRIDANS 2 2
KLEBSIELLA PNEUMONIAE 2 2
ACINETOBACTER 1 1
ENTEROBACTER CLOACAE 1 1
STENOTROPHOMONAS MALTOPHIA 1 1
CANDIDA PARAPSILOSIS 1 1
LEUCONOSTOC SP 1 1
PSEUDOMONAS SP 1 1
Method: All positive and negative blood cultures (lab IT) were combined. HEM/ONC/BMT patient
roster was generated using attending MD numbers, MD names and listed diagnosis in the mirco lab.
Positive and negative blood culture results were extracted using this roster. Duplicate isolates were
excluded (duplicate was defined as same organism and sensitivity pattern; excel, SAS). Only patients
with at least one onc diagnosis are presented (hem/BMT excluded).

14
APPENDIX IV
CHOA-HEM/ONC/BMT SERVICES: SCOTTISH RITE AND EGLESTON
BLOOD CULTURES (10/01-10/02): ANTIBIOTIC SENSITIVITIES.
ALL GRAM NEGATIVES Resistant Intermediate Sensitive Total
AMIKACIN 1 2% 0 0% 51 98% 52
GENTAMICIN 1 2% 1 2% 50 96% 52
MEROPENEM 2 4% 0 0% 50 96% 52
TOBRAMICIN 1 2% 3 6% 48 92% 52
CIPRO 1 2% 4 8% 47 90% 52
CEFEPIME 6 12% 1 2% 45 87% 52
CEFTAZIDIME 5 10% 3 6% 44 85% 52
CEFOTAXIME 9 17% 6 12% 37 71% 52
PSEUDOMONAS AERUGINOSA Resistant Intermediate Sensitive Total
AMIKACIN 0 0% 0 0% 9 100% 9
CEFEPIME 0 0% 0 0% 9 100% 9
GENTAMICIN 0 0% 0 0% 9 100% 9
MEROPENEM 0 0% 0 0% 9 100% 9
TOBRAMICIN 0 0% 0 0% 9 100% 9
CEFTAZIDIME 0 0% 1 11% 8 89% 9
CIPRO 0 0% 2 22% 7 78% 9
CEFOTAXIME 3 33% 3 33% 3 33% 9
PSEUDOMONAS SP Resistant Intermediate Sensitive Total
AMIKACIN 0 0% 0 0% 9 100% 9
GENTAMICIN 0 0% 0 0% 9 100% 9
MEROPENEM 0 0% 0 0% 9 100% 9
CIPRO 1 11% 0 0% 8 89% 9
TOBRAMICIN 0 0% 3 33% 6 67% 9
CEFEPIME 4 44% 0 0% 5 56% 9
CEFOTAXIME 4 44% 0 0% 5 56% 9
CEFTAZIDIME 4 44% 0 0% 5 56% 9
E. COLI Resistant Intermediate Sensitive Total
AMIKACIN 0 0% 0 0% 9 100% 9
CEFEPIME 0 0% 0 0% 9 100% 9
CIPRO 0 0% 0 0% 9 100% 9
GENTAMICIN 0 0% 0 0% 9 100% 9
MEROPENEM 0 0% 0 0% 9 100% 9
TOBRAMICIN 0 0% 0 0% 9 100% 9
CEFOTAXIME 0 0% 1 11% 8 89% 9
CEFTAZIDIME 0 0% 1 11% 8 89% 9

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COAGULASE-NEGATIVE STAPH Resistant Intermediate Sensitive Total
VANCO 0 0% 0 0% 173 100% 173
GENT+CEFOTAX* 34 20% 139 80% 173
GENT+CLINDAMYCIN* 40 23% 133 77% 173
CIPRO+CLINDA* 48 28% 125 72% 173
GENT+AMOXCLAVULANAT* 56 32% 117 68% 173
GENTAMICIN 46 27% 10 6% 117 68% 173
CEFOTAXIME** 35 22% 23 14% 104 64% 162
AMOXCLAVULANAT 62 36% 0 0% 111 64% 173
CLINDAMYCIN 60 35% 2 1% 111 64% 173
CIPRO 76 44% 0 0% 97 56% 173
OXACILLIN 145 84% 0 0% 28 16% 173
PENICILLIN 163 94% 0 0% 10 6% 173
STAPH AUREUS Resistant Intermediate Sensitive Total
AMOXCLAVULANAT 0 0% 0 0% 36 100% 36
CIPRO 0 0% 0 0% 36 100% 36
CLINDAMYCIN 0 0% 0 0% 36 100% 36
GENTAMICIN 0 0% 0 0% 36 100% 36
VANCO 0 0% 0 0% 36 100% 36
CEFOTAXIME** 0 0% 0 0% 35 97% 35
OXACILLIN 2 6% 0 0% 34 94% 36
PENICILLIN 31 86% 0 0% 5 14% 36
STREP VIRIDANS Resistant Intermediate Sensitive Total
VANCO 0 0% 0 0% 21 100% 21
CLINDAMYCIN 2 10% 0 0% 19 90% 21
CEFOTAXIME 10 48% 2 10% 9 43% 21
PENICILLIN 5 24% 9 43% 7 33% 21
ENTEROCOCCUS FAECALIS Resistant Intermediate Sensitive Total
AMPICILLIN 0 0% 0 0% 10 100% 10
GENTAMICIN 0 0% 0 0% 10 100% 10
VANCO 0 0% 0 0% 10 100% 10
*: if sensitive to one or the other, otherwise classified as resistant
**: not all isolates tested

Febrile neutropenia in children

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