Publications by authors named "Martha J Avilés-Robles"

4 Publications

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Safety and efficacy of step-down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial.

Pediatr Blood Cancer 2020 06 20;67(6):e28251. Epub 2020 Mar 20.

Oncology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: It has been suggested that low-risk febrile neutropenia (FN) episodes can be treated in a step-down manner in the outpatient setting. This recommendation has been limited to implementation in middle-income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step-down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low-risk FN.

Procedure: A noninferiority randomized controlled clinical trial was conducted in three hospitals in Mexico City. Low-risk FN was identified in children younger than 18 years. After 48 to 72 hours of intravenous treatment, children were randomly allocated to receive outpatient oral treatment (experimental arm, cefixime) or to continue inpatient treatment (standard of care, cefepime). Daily monitoring was performed until neutropenia resolution. The presence of any unfavorable clinical outcome was the endpoint of interest. We performed a noninferiority test for comparison of proportions.

Results: We identified 1237 FN episodes; 117 cases were randomized: 60 to the outpatient group and 57 for continued inpatient treatment. Of the FN episodes, 100% in the outpatient group and 93% in the inpatient group had a favorable outcome (P < 0.001). The mean duration of antibiotics was 4.1 days (SD 2.5; 95% CI, 3.4-4.8 days) in the outpatient group and 4.4 days (SD 2.5; 95% CI, 3.7-5.0 days) in the inpatient group (P = 0.70).

Conclusions: In our population, step-down oral outpatient treatment of low-risk FN was as safe and effective as inpatient intravenous treatment. Clinical Trials Identifier: NCT04000711.
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http://dx.doi.org/10.1002/pbc.28251DOI Listing
June 2020

[Disseminated aspergillosis due to Aspergillus flavus in a pediatric patient with a recent diagnosis of acute lymphoblastic leukemia].

Bol Med Hosp Infant Mex 2017 Sep - Oct;74(5):370-381. Epub 2017 Jul 18.

Departamento de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México.

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http://dx.doi.org/10.1016/j.bmhimx.2017.05.003DOI Listing
May 2019

Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective.

BMJ Support Palliat Care 2016 Sep 7;6(3):338-43. Epub 2016 Jun 7.

Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Objectives: The prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence of malnourishment among paediatric cancer patients in Mexico City, and assess the association between malnourishment and length of hospital stay.

Methods: Individuals eligible for this study were paediatric cancer patients (aged <18 years) admitted to Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-score<-2 (ie, 2 SDs below the expected mean of the WHO reference population). We estimated time ratios (TRs) and 95% confidence limits (CLs) for the association between malnourishment and length of hospital stay.

Results: Our study population comprised 111 paediatric cancer patients with febrile neutropaenia, of whom 71% were aged <10 years and 52% were males. The prevalence of malnourishment was 14%, equal to a 530% (standardised morbidity ratio=6.3; 95% CL 3.7, 10) excess of malnourishment compared with the world reference population. The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had the shortest length of stay.

Conclusions: Future studies should explore potential interventions for malnourishment to reduce the length of hospital stay or other established adverse consequences of malnourishment.
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http://dx.doi.org/10.1136/bmjspcare-2015-001020DOI Listing
September 2016

Incidence and case-fatality of varicella-zoster virus infection among pediatric cancer patients in developing countries.

Eur J Pediatr 2016 Apr 26;175(4):581-5. Epub 2015 Nov 26.

Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.

Unlabelled: Limited evidence is available about varicella-zoster virus (VZV) infection among pediatric cancer patients in developing countries, which raises questions about the generalizability of VZV vaccine recommendations for pediatric cancer patients (derived from developed countries) to these settings. We assessed the incidence and case-fatality of VZV infection at three institutions in developing countries (Argentina, Mexico, and Nicaragua). Individuals eligible for our study were aged <20 years and actively receiving cancer-directed therapy. We estimated a summary incidence rate (IR) and case-fatality risk with corresponding 95 % confidence limits (CL) of VZV infection across sites using random-effects models. Our study population comprised 511 pediatric cancer patients, of whom 64 % were aged <10 years, 58 % were male, and 58 % were diagnosed with leukemia. We observed a total of 10 infections during 44,401 person-days of follow-up across the 3 sites (IR = 2.3, 95 % CL 1.2, 4.2). The summary case-fatality risk was 10 % (95 % CL 1.4, 47 %) based on one death.

Conclusion: Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. VZV vaccine recommendations for pediatric cancer patients in developed countries may be generalizable to developing countries.

What Is Known: • Current recommendations, based on evidence from pediatric cancer patients in developed countries, contraindicate varicella-zoster virus (VZV) vaccination until completion of cancer-directed therapy and recovery of immune function. • The generalizability of these VZV vaccine recommendations to pediatric cancer patients in developing countries is unknown because of limited information about the incidence and case-fatality of VZV in these settings. What is New: • Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. • VZV vaccine recommendations based on evidence from pediatric cancer patients in developed countries may be generalizable to pediatric cancer patients in developing countries.
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http://dx.doi.org/10.1007/s00431-015-2672-8DOI Listing
April 2016