Vajira Medical Journal: Journal of Urban Medicine

499-506

Authors: Chakrit Eaimkijkarn, Radchapoom Ketkaew

OBJECTIVE: Lymphangitis is a complication often found in lymphedema. It affects patient’s quality of life, morbidity, cosmetic, and functional ability. Potential risk factors of lymphangitis were studied in lymphedema patients of Vajira Hospital. METHODS: This study is a retrospective study. That is, data of lymphedema patients of Vajira Hospital from January 2007 to December 2018 were collected. Demographic data of patients’ gender, age, underlying diseases, BMI, symptoms, site, onset, stages, causes, and types were analyzed to address risk factors using the SPSS program. RESULTS: There were 140 patients participating, consisting of 12 males and 128 females, 78 of which had lymphangitis while the other 62 patients did not have lymphangitis. The average age of patients was 60.09±12.05 years and the average body mass index (BMI) was 28.73±7.81 kg/m2. There were 75 patients having arm lymphedema and 65 patients having leg lymphedema. Additionally, 11 patients had primary lymphedema and 129 patients had secondary lymphedema. The most common complication of lymphedema was lymphangitis (p < 0.001). There was a higher chance for Campisi stages 3, 4 rather than Campisi stages 1, 2 (p < 0.01). The significant presence of wounds was a risk of infection (p < 0.044) in lymphedema patients. The average body weight of patients who had infection was estimated at 74.26 kg, which was higher than that of the non-infected patients, which was at 66.16 +/- 14.67 kg (p = 0.037). CONCLUSION: It is suggested to treat lymphedema since the initial stage, before the symptom reaches its late stage, to reduce the chance of lymphangitis. Besides, patients should be advised to beware of wounds and immediately receive wound treatment to lessen the rate of lymphangitis. Moreover, patients with lymphedema and higher weight are of major concerns as they have more chance to get infected.

519-526

Authors: Oranooj Lertkovit, Daranee Isaranimitkul, Taweewong Tantracheewathorn

OBJECTIVE: To evaluate the clinical characteristics and outcomes of pediatric cancer with non-neutropenic fever (NNF) in pediatric cancer patients in the absence of a central venous catheter. METHODS: This single-center retrospective cohort study enrolled pediatric patients with cancer (age < 18 years) who received chemotherapy treatment at the Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from January 2016 to July 2020. Clinical characteristics and outcomes of NNF episodes were described. Descriptive statistics were analyzed. RESULTS: Fifty-one patients were reviewed, but the 97 NNF episodes were documented from 32 patients. Only One (of the 51 patients) had subcutaneous port. The most frequent cancer diagnosis was acute lymphoblastic leukemia (51%). NNF occurred in 3.8 per 1,000 days of chemotherapy period (95% confidence interval [CI] 3.1–4.6). The most frequently clinically documented infections were respiratory tract infection (35%), urinary tract infection (11%), and gastrointestinal infection (10%). The causative pathogens could not be demonstrated in 67.1% of NNF episodes. The commonly identified pathogens were viruses (12.3%), gram-negative bacteria (10.3%), and gram-positive bacteria (5.2%). Empiric treatment with antibiotic was initiated in 92.8% of the total episodes. Ceftriaxone was the most common antibiotic of choice. Only one episode had a positive hemoculture. Four (4.1%) episodes required intensive care unit admissions, and only one NNF-related mortality due to the human Bocavirus pneumonia and multi-organ failure occurred. The mortality rate of NNF was 3.1%. CONCLUSION: NNF episodes are common and life-threatening complications among pediatric cancer patients and generally lead to hospitalization. The incidence of NNF was 3.8 per 1,000 days of chemotherapy (95% CI 3.1–4.6). The causative pathogen in 67% of NNF episodes was unknown, and the commonly identified pathogens were viruses. However, many patients did not identify any causative bacteria, and they received intravenous antibiotics and were hospitalized. The results of our study suggest that patients with severe symptoms may indicate early evaluation and prompt management for viral infection, especially in a patient with a negative bacterial culture and poor respond to antibiotic treatment. This study reveals baseline information for future cohorts to provide guideline management of this common complication during cancer treatment.

535–542

Authors: Theerameth Pruangmethangkul, Thiraporn Kanjanaphan

OBJECTIVE: The results of adequate and inadequate empirical antibiotics remain unclear. This study aimed to evaluate the results of using adequate and inadequate empirical antibiotics. METHODS: A retrospective cohort analysis that covered January 2017 and December 2021 was conducted. At Vajira Hospital, we enlisted pediatric patients with bacteremia and urinary tract infections (UTIs). Patient attributes, empirical antibiotics, therapeutic results, financial expenditures, and antibiotic susceptibility patterns were assessed. RESULTS: In total, 286 pediatric patients were enrolled. There were 230 (80.4%), and 56 (19.6%) patients with UTIs and bacteremia, respectively. The organism that was found the most frequently was Escherichia coli (53.5%), while third-generation cephalosporin was the most often used empirical antibiotic (74.5%). Only 78.4% of Escherichia coli were vulnerable to third-generation cephalosporin. Of 220 patients (76.9%) were treated with adequate empirical antibiotics. The outcomes in the adequate empirical antibiotics group revealed better-improved symptoms than inadequate empirical antibiotics group (96.4% VS 84.8%, p = 0.002). CONCLUSION: Clinical outcomes among pediatric patients from adequate initial antibiotics groups were reported the better outcomes. The mortality rates were not different. Nonetheless, appropriate empirical antibiotics are needed. In UTI patients, amikacin is preferable options for empirical antibiotics.