Episodes of Fever and Neutropenia in Children With Cancer in a Tertiary Care Medical Center in Turkey

Abstract

The aim of this study was to determine the clinical features and microbiological spectrum during episodes of fever and neutropenia (FEN) in children with cancer. Demographics, clinical information, treatment approaches, and outcomes of the patients admitted to Akdeniz University Department of Pediatric Hematology and Oncology from October 1996 to June 2004 were evaluated retrospectively. Of the total 621 episodes, 345 (55.5%) were microbiologically documented (MDI) (36.4%) or clinically suspected (CSI) (19.2%) infections. A total of 425 infections were diagnosed in 345 episodes, in which lower respiratory tract infections were the most common (32.7%). Among the microbiologically documented infections, Staphylococci (both coagulase-negative and coagulase-positive) (38.7%) and Escherichia coli (12.9%) were the most frequently isolated gram-positive and gram-negative organisms, respectively. Monocytopenia less than 100/microL (p = 0.01), duration of neutropenia (p = .01) and fever (p < .001) were significantly associated with documented infection by univariate analysis. In addition, presence of previous FEN episode (p = .001) and hypotension (p = .029) were also found to be risk factors. However, using the multivariate analyses, only the duration of fever was found to be an independent risk factor for MDI. The rate of mortality was significantly higher among under 1-year-old patients (p = .039). Hypotension and uncontrolled cancer were the significant determinants of poor prognosis. These results may help to consider a more selective management strategy for children with these problems.

The Microbiologic Pattern in Pediatric Cancer Patients with Febrile Neutropenia and Bacteremia: A Referral Hospital-Based Study in Northwest of Iran

“…The mean age of the investigated patients was about 5 years, almost 1 year younger than cases presented in the studies of Hakim et al (3), Castagnola et al (10), and Gupta et al (17), and 2 years younger compared to other studies (6,10,18,19). This can be attributed to the methods used for identification and referral of the patients.…”

Bacteriological profile by blood culture among acute lymphoblastic leukemic children hospitalized with neutropenia and fever in a tertiary level hospital, Bangladesh.

“…and Esch coli were the most frequently isolated organisms. Tezcan et al 17 in their study among children with neutropenia and cancer Staphylococci and Escherichia coli were the most commonly isolated organisms.…”

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

“…etiología Al analizar la causa de la fiebre, los estudios indican que la mayoría de los casos son secundarios a una infección 3,13,15 ; pudiendo ser de origen viral, fúngica o bacteriana, siendo la infección bacteriana la complicación más frecuente con presentación más temprana durante el episodio febril en un paciente neutropénico 2 . La identificación del origen de la infección se logra solo en el 30% a 50% de los casos 15,17 , y cuando se reconoce el foco, este generalmente corresponde a infecciones del tracto respiratorio superior e inferior como neumonía, sinusitis y otitis, estas dos últimas en menor frecuencia 3,15,18 . También se han reportado casos a nivel de sistema gastrointestinal con infecciones que varían desde gastroenteritis, mucositis y esofagitis, hasta enterocolitis neutropénica o tiflitis.…”

“…El sistema urinario es una foco de infección importante reportándose una frecuencia de hasta el 26% en la literatura mundial 6,17,19 , con menor frecuencia en estudios locales (2,5%)…”

“…La terapia combinada es superior en ciertas circunstancias, por ejemplo, en infecciones severas ocasionadas por P. aeruginosa 31 , sin embargo, las guías indican que ambas aproximaciones tienen resultados similares, con mayor probabilidad de efectos secundarios con la terapia combinada 17,28,31,32 . Por otro lado, la ciprofloxacina está indicada junto con la clindamicina o la vancomicina como alternativas para los pacientes alérgicos a betalactámicos 12 .…”