Etiologic, Microbiologic, Clinical and Outcome Characteristics of Febrile Neutropenia in Children with Malignancy

Journal Of Leukemia, vol.10, no.4, pp.1000299, 2022 (Peer-Reviewed Journal)

ABSTRACT

Background: The purpose of this study is to examine the clinical, laboratory findings and treatments of pediatric

patients who were followed up in our clinical institute for malignancy and those who had Febrile Neutropenia (FEN)

attacks.

Materials and methods: 55 patients between the ages of 1-17 and 83 episodes of FEN who were followed up and

treated for cancer in our Pediatric Hematology- Oncology clinic between January 2019 and June 2019 were examined

cross-sectionally. Patients with Absolute Neutrophil Count (ANC) <500/mm³ were included in the study. Febrile

neutropenia was diagnosed in neutropenic patients with a single measurement of body temperature ≥ 38.3°C (101°F)

or ≥ 38.0°C (100.4°F) for a period of 1 hour. The demographic information of the patients, laboratory and physical

examination findings, FEN risk groups, the most recent chemotherapy protocols, fever and neutropenia durations,

fever foci, culture reproduction, and treatments started were recorded in a standard form.

Results: Among 83 FEN attacks included in the study, 28 of the patients were female (34%) and 55 were male

(66%). The median age was 5.5 (range 1.1-16.7) years. Sixty-six (80%) of the patients were being followed up for

leukemia and 17 (20%) for solid tumors. The average number of attacks per patient was 1.4 (1-4) attacks. According

to the risk classification of febrile neutropenia, 80 attacks (96%) were classified as high risk and 3 attacks (4%) as

low risk. Mean duration of fever was in patients with leukemia and in patients with solid tumors. Mean duration

of neutropenia was significantly higher versus 1.9 ± 1.3 days to 1.9 ± 1.1 days in patients with leukemia than

those treated for solid tumors (p˂0.05). The most common microorganism was Coagulase negative staphylococcus.

Galactomannan was positive in one patient and Enterobacter growth was detected in the blood culture.

Conclusion: Febrile neutropenia is among the important causes of mortality in cancer patients. Most of the attacks

in our study were high-risk FEN attacks. The reason for this may be duration of active chemotherapy, prolonged

neutropenia periods, remission status of cancer, and delays related to hospitalization of patients. Fever focus is often

not detected in FEN attacks; the most common fever focus in our study was mucositis. The most common gram-

positive microorganisms were found in the blood culture of our patients. This study is important in terms of creating

up-to-date algorithms in the treatment and management in FEN patients. However, the results to be obtained by

conducting studies with more patients will be more beneficial in this senses.

Keywords: Febrile neutropenia; Children; Cancer