Febrile Neutropenia in Pediatric Oncology: Prevalence and Risk-Factors for Bacterial and Fungal Infection

Abstract

Febrile neutropenia (FN) is a frequent complication pediatric cancer treatment and is associated with serious infections and death. Most FN episodes resolve without a diagnosable infection, however, which leads to ongoing interest in the epidemiology of infection among children with chemotherapy-induced FN and risk factors for serious bacterial or fungal infection. We retrospectively studied 199 consecutive episodes of FN in a cohort of children with cancer at an American tertiary care hospital. Median age of the cohort was 6.1 years (range 0.3 to 24.1), and the most common diagnoses were acute leukemia and brain tumors. At least one bacterial or fungal infection complicated 43 episodes (21.6%), most commonly Gram-positive bacteremia. Invasive fungal infections complicated 2.5% of episodes, most commonly involving the lung. Overall mortality was 1% and infection-related mortality was 0.5%. Most infections were diagnosed within 4 days of fever onset. To evaluate risk factors for bacterial or fungal infection we conducted a nested case-control analysis. Odds of infection were higher in children with trisomy 21 or acute myeloid leukemia, although these associations did not meet statistical significance. Odds of infection were significantly higher if children had a prior history of a bacterial or fungal infection. Children with FN may benefit from initial close observation, but prolonged hospitalization may be unnecessary, especially for those who do not have a prior history of infection.