Etiologic, microbiologic, clinical and outcome characteristics of febrile neutropenia in children with malignancy

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 institue for malignancy and those who had febrile neutropenia (FEN) attacks. Material 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 Pedaitric 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, prelonged 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 sense.