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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0044-1788702
Original Article

Clinical Profile of Febrile Neutropenia in Children with Malignancies in a Tertiary Care Hospital: A Prospective Observational Study

Ayesha Mariam
1   Department of Paediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
,
Niranjan Gurunath Hegde 
2   Department of Paediatric Hemato-Oncology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
,
Arathi Srinivasan
2   Department of Paediatric Hemato-Oncology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
,
Ravikumar Thangadorai
2   Department of Paediatric Hemato-Oncology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
› Author Affiliations Funding None.
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Abstract

Introduction: Febrile neutropenia is a dreadful complication associated with malignancies. Knowledge of locally prevalent pathogens and their resistance pattern is of paramount importance in guiding antimicrobial therapy.

Aims/Objectives: The aim of the study was to identify the common infectious agent, antibiotic susceptibility of culture positive patients, and outcome

Methods: We conducted a single-center prospective observational study. Forty-three children with febrile neutropenia episodes admitted in KKCTH, Chennai, were included in the study. The duration of the study was 1 year. Relevant patient and disease specific details were obtained, results were analyzed, and conclusions were drawn.

Results: There were 90 episodes of febrile neutropenia. Overall culture positivity was identified in 37 cases (41.11%). Bacteremia (23.3%) was the most common cause of microbiologically documented infection. Gram-positive organisms (60%) were more commonly documented. Among the gram-positive organisms, coagulase-negative Staphylococcus aureus was the predominant isolate followed by Streptococcus. Central line–associated bloodstream infections were documented in 13.33%. Chemo-port removal was done in four children. Three had invasive fungal disease. The majority of the gram-negative isolates were resistant strains. Morbidity was significantly more in gram-negative infections. Overall outcome was good though three children succumbed to sepsis.

Conclusion: A vigilant management of illness is essential. Chemo-port carries risk of severe infection. Protocol-based management of catheter-related bloodstream infection (CRBSI) can limit the number of chemo-port removal. Though gram-positive organisms are in the rise, gram-negative organisms are still responsible for significant morbidity. Early initiation of broad-spectrum empirical antibiotics with optimal gram-positive coverage is crucial. Children with suspected fungal infections should be aggressively evaluated and treated. An organized approach is the key in successful management.

Keywords

acute lymphoblastic leukemia - CRBSI - microbiologically documented infection - invasive fungal disease - gram-negative organism

Ethics Committee Approval

This study was approved by the CHILDS Trust Medical Research Foundation ethical committee (ECR/676/Inst/TN/2014/RR – 17).


Presentation at a Meeting

Oral paper presentation in Tamil Nadu State Pedicon 2019, Indian Academy of Pediatrics, in Tamil Nadu.


Authors' Contribution

A.M. contributed to the concepts, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, and manuscript preparation. N.G.H. contributed to the definition of intellectual content, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review. A.S. contributed to the concepts, design, definition of intellectual content, manuscript editing, and manuscript review, and is also a guarantor. R.T. contributed to the concepts, design, and manuscript review, and is also a guarantor.


Patient Consent

Informed Patient consent was obtained for this study.




Publication History

Article published online:
05 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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