Febrile Neutropenia in Pediatric Cancer Patients Receiving Chemotherapy at Faculty of Medicine Vajira Hospital, Navamindradhiraj University
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Abstract
Objective: To study the prevalence, type of bacteria and site of infection that cause febrile neutropenia in pediatric cancer patients receiving chemotherapy.
Methods: A retrospective study from medical record of patients under 15 years of age diagnosed with febrile neutropenia receiving chemotherapy and admitted at the Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University from January 1st , 2011 to September 30th , 2016.
Results: There were 40 patients with 96 episodes of febrile neutropenia, male 50% and female 50%. The predominant underlying malignancies were solid tumor 18 patients (45%) followed by acute lymphoblastic leukemia 15 patients (37.5%). Causes of febrile neutropenia were identified 54.2% (pneumonia 14.6%, acute gastroenteritis 12.5%, urinary tract infection 10.4%, mucositis 9.4%, bacteremia 9.4%). The prevalence of bacterial infection was 27.1%. The organisms were gram negative 89.7 %(E. coli 34.6 %, P. aeruginosa 19.2%, K. pneumoniae 15.4%) and gram positive 10.3% (Enterococcus spp. 66.7% and methicillin sensitive S. aureus 33.3%). The most common empirical antibiotics were ceftazidime plus amikacin (68.7%). The antibiotics were changed after treatment 48 hours because of clinical worsening 21%. The next antibiotics used were meropenem 31.2%, vancomycin 16.6% and add amphotericin B 14.6%. Treatment outcomes were recovery (84.4%), with complications (10.4%) and death (5.2%). The risk factors of death in this study was duration of febrile neutropenia more than 7 days (Adjusted OR 22.0; 95%CI: 2.3 – 211.7; p 0.007)
Conclusion: The prevalence of bacterial infection in febrile neutropenia was 27.1%. The organisms were gram negative 89.7 % (E. co li, P. aeruginosa, K. pneumoniae) and gram positive 10.3% (Enterococcus spp. and methicillin sensitive S. aureus). The common sites of infection were pneumonia, gastroenteritis, urinary tract infection, mucositis and bloodstream infection. The risk factors of death was duration of febrile neutropenia more than 7 days.
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References
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