Febrile neutropenia in pediatric cancer patients: Experience from a tertiary health care facility of Pakistan

Alam, Muhammad Matloob; Fadoo, Zehra

doi:10.1016/j.pid.2014.06.002

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…In the current study, majority of the patients with FN were in the age group of 1 to 6 years (66%) when compared to those above 6 years. It is possible that there are differences in the primary cancer type, pharmacokinetics of chemotherapy received, and its tolerance among the two age groups [5]. A paediatric study conducted by Inaba et al also reports the same [9].…”

Section: Discussionmentioning

confidence: 97%

“…The causative microorganisms in blood culture were demonstrated in 70-80% of FN episodes [3]. However, majority of gram-negative microorganisms was responsible for causing 80% of infections in FN patients [5]. The choice of empirical therapy should be based on a variety of factors such as patient infection risk, known local epidemiology of infections, local antimicrobial sensitivity and resistance patterns, and available evidence from the literatures.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia

Abraham

George

Sajith

et al. 2019

SN Compr. Clin. Med.

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Febrile neutropenia (FN) is the most common haematological toxicity associated with cytotoxic chemotherapy. Individual studies are available, but national estimates on FN are required. To describe chemotherapy-induced neutropenia, its associated infection-causing organisms, and the antimicrobials prescribed, a prospective cum retrospective study was conducted for a period of 9 months, which included 50 paediatric cancer patients less than 18 years. Patients having an absolute neutrophil count (ANC) less than 1500/mm 3 , having body temperature of above 38.5°C, and receiving anti-infectives as prophylaxis were included. Patient demographic details, presenting complaints, absolute neutrophil count, and laboratory findings were noted in a patient proforma. Out of the overall 584 episodes of CIN, 188 episodes (32.2%) were of febrile neutropenia. Majority of patients were boys (70%), aged between 1 and 6 years (66%), and diagnosed with acute lymphoblastic leukemia (64%). The mean ANC was 765.6 ± 235.7 × 10 9 /l. From a total of 188 episodes of FN, in 179 episodes, patients had ANC < 500 mm 3 , whereas in 9 episodes, patients had ANC < 100 mm 3. The predominant site of infection in these patients was bloodstream (27%), followed by urine (6%) and stool (1%). From the 51 episodes of blood culture done, the highest reported was of Staphylococcus species (49.01%). Anti-infective combinations of piperacillin/vancomycin (56%) and piperacillin/amikacin (42%) were given. Patients with positive fungal growth received Inj. amphotericin (18%) as therapy. Majority of the children undergoing chemotherapy, diagnosed with ALL, had FN. Low ANC led them susceptible to various bacterial and fungal infections. Introduction to antimicrobials and antifungals have all contributed to decreasing chemotherapy-related infections.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia

Abraham

George

Sajith

et al. 2019

SN Compr. Clin. Med.

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“…A study of tertiary health care center of Pakistan, found that out of 872 episodes of febrile neutropenia; where 1.4% expired. 13 In the current study among the adverse events; mortality was higher 11.76% and 2.9% of patients required PICU admission, 8.8% needed aggressive fluid resuscitation. This poor outcome in LMIC is may be due to lack of supportive care; limited facilities of isolation and intensive management for most of the critically ill patients.…”

Section: Discussionmentioning

confidence: 49%

Outcome of Febrile Neutropenia in Children with Cancer: Experience from a Tertiary Health Care Center

Kaes¹,

Islam

Jamal

et al. 2023

Khwaja Yunus Ali Medical College Journal

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Background: Febrile neutropenia (FN) is a serious event in children with cancer; associated with various complications and mentionable adverse outcome.Objective: To identify the outcome of febrile neutropenia in children with cancer.Materials and methods: This prospective observational study was conducted from October 2017 to November 2018 in the Department of Pediatric Hematology and Oncology, BSMMU. Children (age<18years) with malignancy who were admitted with febrile neutropenia or admitted patients who had developed febrile neutropenia onward were enrolled in this study. Finally, the outcome of each episode of FN was analyzed.Results: Total of 61 patients with 68 febrile neutropenic episodes were studied. Male patients were 62.29% and female patients were 37.70% with a mean age of 7 years. Majority were ALL (50.8%) followed by AML (29.5%), NHL (11.4 %) and solid tumor (8.1%). Bacterial infection was confirmed by culture in 14.7% episodes, 11.7% episodes had positive blood culture. Most of the isolated organisms were gram-negative (90%). Cough (39.7%), bleeding (19%) and diarrhea (17.64%) were the common clinical manifestations in those febrile neutropenic episodes. The mean duration of neutropenia was 9 days, 55.88% of episodes had prolonged neutropenia. Profound neutropenia was recorded in 47 % episodes and significantly associated with adverse outcome. Age ≥10 years also significantly associated with adverse outcome. The treatment success rate was achieved in76.4 % of episodes. A composite adverse event was observed in 23.52% of episodes; with mortality in 11.76%.Conclusion: Febrile neutropenia was a common complication in hematological malignancy. Although 76.4% episodes of febrile neutropenia had been treated successfully, mortality was significantly higher 11.76%. Profound neutropenia and age ≥10 were significant risk factors for dreadful outcome. KYAMC Journal Vol. 14, No. 01, April 2023: 07-10

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“…17 The response rate to 1st and 2nd line antibiotics in our setup could be compared with data from other studies from Pakistan and developed countries but treatment-related mortality (TRM) was high due to infection. 18 More multicenter studies are needed to establish a standard approach to decide the need of blood culture and to define optimal initial empirical antimicrobial therapy, its duration and risk stratification in a way that sustains safety, minimizes financial burden and maximizes the quality of care by reducing overall treatment-related mortality in FN children with common malignancy.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Induced Neutropenic Fever and Its Response to Empirical Antimicrobial Therapy

Murtaza

Maryam

Iqbal

et al. 2022

PAFMJ

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Objective: To find out the frequency of chemotherapy-induced febrile neutropenia (FN) in children diagnosed with Acute Lymphoblastic Leukemia (ALL) and its response to empirical antibiotic therapy. Study Design: Cross-sectional study. Place and Duration of Study: Department of Peadiatric Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Nov 2017 to Oct 2018. Methodology: Newly diagnosed pediatric patients suffering from acute lymphoblastic leukemia between 1 to 15 years of age were included. All patients were treated with chemotherapy according to the United Kingdom National Randomized Trial for Children and Young adults with Acute Lymphoblastic Leukemia (UKALL) 2011 protocol. Patients with febrile neutropenic (FN) episodes were treated with empirical antimicrobial therapy as per hospital guidelines. Patients ‘response to antimicrobial therapy, blood culture results and related complications were noted. Results: Out of a total 77 patients, 45 (58.4%) had 69 episodes of febrile neutropenia (FN), 62 (78.5%) episodes of febrile neutropenia (FN) were started empirical treatment with first-line antibiotics (piperacillin-tazobactam and amikacin) whereas 15 (21.7%) episodes of febrile neutropenia (FN) not responding to the 1st line were shifted to second-line antibiotics (meropenem and amikacin). Mean duration of fever was 4.1 ± 2.8 days on 1st line antibiotic regimen, 2.6 ± 1 days on 2nd line antibiotics and 6.3 ± 3.3 days on combination with antifungal drug. Ten patients received antifungal therapy empirically. Efficacy of the 1st line and the 2nd line was 72.5% and 77% respectively. Staphylococcus aureus was the most frequent organism isolated from blood culture results. During the induction phase, 10 (12.9%) patients..............

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Febrile neutropenia in pediatric cancer patients: Experience from a tertiary health care facility of Pakistan

Cited by 3 publications

References 24 publications

Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia

Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia

Outcome of Febrile Neutropenia in Children with Cancer: Experience from a Tertiary Health Care Center

Chemotherapy Induced Neutropenic Fever and Its Response to Empirical Antimicrobial Therapy

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