Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Abstract

Objective: Pediatric cancer patients with prolonged febrile neutropenia have increased risk for severe, recurrent or new bacterial and fungal infection. The aim of this study was to identify the risk factors associated with adverse outcomes in this group. Methods:We retrospective analyzed the clinical data of 135 hospitalizations of pediatric cancer patients with prolonged febrile neutropenia from a tertiary health care center of Pakistan. Results:The mean age of the study population was 7.3±4.1 years. There were 98 (72.6%) males and 37 (27.4%) females. Acute leukemia with 88 patients (65.2%) was the most common diagnosis followed by lymphomas 19 patients (14.1%) and solid tumors. Cause of febrile neutropenia was identified in only 58 (43.0%) patients, out of them blood stream infections were found in 22 cases (16.3%), pneumonia in 15 (11.1%), fungal infection in 13 (9.6%), infectious diarrheas in 5 (3.7%) and urinary tract infection (UTI) in 3 (2.2%) of cases. The composite adverse event outcome was observed in 28 (20.7%) of patients, with in-hospital mortality occurring in 7 (5.2%), Pediatric intensive care unit (PICU) admission occurring in 12 (8.9%) and inotropic support was required in 9 (6.7%). On logistic regression analysis AML (Adjusted odds ratio (AOR), 7.6; P<0.001), neutropenia <50/mm 3 (AOR, 10.8; p<0.001), platelets count <50,000/mm 3 (AOR, 5.2; p<0.001), BSI (AOR, 2.3; p 0.05) and fungal infection (AOR, 4.3; p<0.001) were found as independent risk factors for composite adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia.Conclusions: AML, severe myelosuppression, blood stream infections and fungal infection were identifiable risk factors associated with development of adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia. J Microbiol Infect Dis 2016;6(2): 69-73Key words: Febrile neutropenia, pediatric, oncology, adverse outcome Uzamış Febril Nötropeni ile Pediatrik Kanser Hastalarında Karma Olumsuz Durum SonuÖZET Amaç: Uzamış febril nötropeni pediatrik kanserli hastalarında ağır seyirli yeni tanı veya tekrarlayan bakteri ve mantar enfeksiyonu riski artmıştır. Bu çalışmanın amacı, bu grupta olumsuz sonuçlarla ilişkili risk faktörlerini belirlemektir.Yöntemler: Pakistan'ta bir üçüncü basamak sağlık merkezine uzamış febril nötropeni nedeni ile izlenen pediatrik kanser hastalarının 135 hastane yatış epizotu retrospektif olarak analiz edildi. Bulgular: Çalışma grubunun yaş ortalaması 7,3 ± 4,1 yıl idi. Hastaların 98'i (% 72,6) erkek ve 37'si (% 27,4) kadındı. Akut lösemi 88 hastada (% 65,2) ile birinci sırada, lenfoma 19 hasta (% 14,1) ile ikinci sırada idi ve diğer hastalarda solid organ tümörleri en sık görülen tanı olarak saptandı. Febril nötropenin nedeni sadece 58 (% 43,0) hastada tanımlandı. Bu hastalardan 22 olguda (% 16,3) kan akımı enfeksiyonu (KAE), 15 hastada pnömoni (% 11,1), fungal infeksiyon 13 (% 9,6) hastada, ve enfeksiyöz diyare 5 hastada (% 3,7) ve üriner sitem enfeksiyonu 3 (% 2,2) hastada saptandı. Karma olumsu...