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• W2331342695 abstract "Infectious complications are still a major cause of morbidity and mortality in pediatric cancer patients. Fever is usually the first and only sign of bacterial infection because other signs of infection are typically attenuated during neutropenia (1). Because delaying antibiotic treatment until identification of the cause of fever may have lethal consequences, standard care for pediatric hematopoeitic stem-cell transplantation (HSCT) patients with febrile neutropenia is empirical treatment with broad-spectrum antibiotics. However, an actually proven bacterial infection is documented in only 35% to 50% of these patients (2–5). Other causes of fever in HSCT patients are viral or fungal infections, mucositis, conditioning regimens, and graft-versus-host disease. CRP is currently widely used as a diagnostic marker for bacterial infection, but CRP levels do not rise significantly until 24 to 48 hr after onset of inflammation, and the specificity is low (6, 7). The cytokine interleukin (IL)-8 has been described to be a promising marker of bacterial sepsis in febrile neutropenic pediatric cancer patients (8). We evaluated the diagnostic value IL-8 compared to CRP for the rapid detection of bacteremia in pediatric HSCT patients with febrile neutropenia. We included all children, age ranging from 0 to 18 years, undergoing HSCT with serotherapy as part of the conditioning regimen in the pediatric transplant unit of the Leiden University Medical Center, Leiden, the Netherlands, from January 2009 until November 2010. Local ethical committee approval for the study was obtained, and all patients and their parents, dependent on patient age, gave written informed consent for participation. The IL-8 and CRP levels were measured on day 1 and day 2 of febrile neutropenia and were compared between patients with and without bacteremia. The IL-8 was also determined during nonfebrile episodes and during the administration of serotherapy. Distribution of data was described in a median value and range, because of the nonnormal distribution of these values. Accordingly, comparison between groups was performed using nonparametric tests. A total of 52 febrile neutropenic episodes in 32 children undergoing 36 allogeneic HSCTs were included. In 11 of the 52 (21%) febrile neutropenic episodes, a positive blood culture was documented. The majority of bacteremias in our cohort (57%) were caused by gram-positive bacteria, the most common isolates being streptococcus species and the low virulent coagulase-negative staphylococci (at least two positive blood culture bottles). The IL-8 levels were low during nonfebrile episodes (median, 15.9 ng/L; range, <5–70.1 ng/L). The median IL-8 level at day 1 of febrile neutropenia was significantly higher in patients with bacteremia than in patients without bacteremia (240 vs. 79 ng/L, respectively, P=0.010) (see Fig. 1). The same accounted for median IL-8 levels at day 2 (457 vs. 213 ng/L, respectively, P=0.022). Although median IL-8 levels were higher in bacteremia caused by gram-negative bacteria than during gram-positive bacteremia (678 vs. 140 ng/L, respectively), no significant difference was found (P=0.11). There were no differences in CRP levels at day 1 and day 2 of fever in neutropenic patients with and without bacteremia.FIGURE 1: IL-8 and CRP levels at days 1 and 2, respectively, of febrile neutropenia in patients with and without bacteremia. The horizontal lines represent the median. IL-8 is shown on a log 10 scale at the y axis because of widespread values.Serotherapy with rabbit antithymocyte globulin or Alemtuzumab started approximately 5 days before HSCT, and the final dose was given on day 2. We tested IL-8 levels in 11 patients who received serotherapy. All patients developed fever on the first day of serotherapy. A high peak in IL-8 levels developed shortly after completing the first dose of serotherapy compared to the day before (median, 3184 vs. 13 ng/L, respectively, P=0.012). Approximately 12 hr after the first dose of serotherapy, IL-8 levels had fallen significantly to a median of 254 ng/L (P=0.018). No increase was seen in IL-8 levels after the next doses of serotherapy, and IL-8 levels had returned to normal at the time of HSCT. In conclusion, we showed that IL-8 is a potentially good marker for the early detection of bacteremia in pediatric patients with HSCT and better than CRP in distinguishing febrile neutropenic patients with and without bacteremia. After the first dose of serotherapy, a transient and high peak of IL-8 was observed. Therefore, IL-8 does not seem to be a valuable marker to identify bacterial infection during serotherapy. However, persistently high IL-8 levels after serotherapy may be an indication of a bacterial infection, and based on our findings, we would recommend that appropriate antibiotic treatment should be started. Based on this study, it seems feasible to explore in a prospective, larger study the diagnostic value of IL-8 and whether measurement of IL-8 levels, possibly in conjunction with other biomarkers, can contribute in determining which pediatric HSCT patients with febrile neutropenia require antibiotics and in whom antibiotics might be reduced or withheld. Karin G.E. Miedema 1 Clementien L. Vermont2 Lynne M. Ball2 Eveline S.J.M. de Bont1 Willem A. Kamps1 Maarten J.D. van Tol2 Cornelia M Jol-van der Zijde2 Wim J.E. Tissing1 1 Department of Pediatric Oncology and Hematology Beatrix Children’s Hospital University Medical Center Groningen University of Groningen Groningen, the Netherlands 2 Department of Pediatrics Leiden University Medical Center Leiden, the Netherlands" @default.
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• W2331342695 date "2014-10-27" @default.
• W2331342695 modified "2023-10-16" @default.
• W2331342695 title "The Diagnostic Value of Interleukin-8 for the Detection of Bacteremia in Pediatric Hematopoietic Stem Cell Recipients With Febrile Neutropenia" @default.
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• W2331342695 doi "https://doi.org/10.1097/tp.0000000000000434" @default.
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