Prevalence of Pathogens in Pediatric Cancer Patients with Febrile Neutropenia Induced by Chemotherapy at Ratchaburi Hospital

Abstract

Objective: The aim was to determine the prevalence of pathogens in pediatric cancer patients with febrile neutropenia (FN) following chemotherapy at Ratchaburi Hospital from 2018 to 2022.

Methods: The study retrospectively performed chart reviews from medical records of pediatric cancer patients under 15 years old diagnosed with FN from January 2018 to December 2022.

Results: We identified 92 cancer patients with 195 FN episodes. FN in hematologic malignancies accounted for 92.8%. The most frequent infection sites were urinary tract (22.5%), bloodstream (13.8%), respiratory tract (13.6%), and gastrointestinal tract (11.8%).          Of 551 culture samples, 220 were positive. Gram-negative bacteria were predominant (68.4%), with Escherichia coli (24.5%), Klebsiella pneumoniae (23.1%), and Pseudomonas aeruginosa (11.9%) being the most common. Gram-positive bacteria accounted for 31.6%, primarily Enterococcus faecium (31.8%), Staphylococcus haemolyticus (19.7%), and coagulase-negative staphylococci (12.1%). Fungal infections were found in 5% of cases. The mortality rate was 12%. Statistically significant risk factors of death included FN duration >7 days (OR 5.3, 95% CI: 1.5–18.4, p-value = .03); central venous catheter used (OR 55.7, 95% CI: 6.9–452.5, p-value < .001); urinary catheter used (OR 9.5, 95% CI: 2.1–43.7, p-value = .004); endotracheal intubation (OR 62.7, 95% CI: 13.8–285.4, p-value < .001); and high-risk patient status (OR 5.3, 95% CI: 1.5–18.4, p-value = .009).

Conclusion: Urinary tract infections were the most common cause of FN, followed by bloodstream and respiratory tract infections. Gram-negative bacteria were predominant. Mortality risk factors included prolonged FN, invasive devices used, and high-risk patient status. Thus the results can be useful for handing FN early and efficiently.