Significance of Laminar Air Flow Room for the Reverse Isolation in Neutropenic Cancer Patients.

Infection is one of the most important causes of death in cancer patients. So many physicians make every effort to control the infection, especially in neutropenic cancer patients. The aim of this study is to find out the role of HEPA filter equipped laminar air flow room reverse isolation for the management of chemotherapy induced febrile neutropenic children with cancer. We evaluated febrile neutropenic patients following chemotherapy from January 2003 to April 2006 at the Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea. They were promptly managed by antibiotics and antifungal agents and if possible, they were isolated in the aseptic room. They were allocated to three groups of standard ward care, isolation after onset of fever and isolation before onset of fever. Profiles of infection, clinical courses and survival rate were compared among three groups. One hundred and nine episodes of febrile neutropenia from thirty eight cancer patients were observed. Twenty nine were boys and nine were girls with their median age were 5.5 years. The diagnoses included acute leukemia (36.8%), malignant lymphoma (15.8%), and other solid tumor (47.4%). Fifty five episodes were included to standard ward care, forty four episodes to isolation after onset of fever and thirteen episodes to isolation before onset of fever. We found out that one in thirteen episodes of isolation before onset of fever (8%) and twenty six in ninety six episodes in other groups (27%) were microbiologically or clinically defined infections. Fifty six episodes recovered and only one died of infectious cause both isolation after and before onset of fever group, especially all recovered in isolation before onset of fever group. Forty eight episodes recovered and four died in general ward care group, but there was no statistical difference among three groups (p=0.93). Age, sexual difference, underlying disease, absolute neutrophil count (ANC), duration of ANC recovery and incidence of disseminated intravascular coagulation were no difference among three groups. In early isolated group, duration of fever and antibiotics medication were significantly shorter (p=0.002, 0.009) and CRP level was lower than other two groups (p=0.04). Reverse isolation in laminar air flow room for neutropenic cancer children before onset of fever affect the durations of fever and antibiotics treatment with beneficial effect.