Incidence and Outcomes of Febrile Neutropenia in Pediatric Cancer Patients: A Retrospective Descriptive Study
Keywords:
Incidence, Febrile neutropenia, Pediatric cancer, Antibiotic, OutcomeAbstract
Background: Febrile neutropenia is the most common life-threatening complication of pediatric cancer patients. Early diagnosis and empirical antibiotic administration especially within 60 minutes improve outcomes and reduce mortality from febrile neutropenia.
Objective: To investigate on the incidence rate of febrile neutropenia, time to antibiotic, and outcomes of patients.
Study design: A retrospective descriptive study
Material and methods: Pediatric cancer patients less than 15 years of age who were diagnosed with febrile neutropenia in Pediatric Department, Bhumibol Adulyadej Hospital between 1st January 2012 and 31st December 2018 were reviewed and analyzed. The protocol was approved by the ethic review committee.
Results: There were fifty-four patients with 170 episodes of febrile neutropenia in this study. The incidence of febrile neutropenia was 5.58 per 1,000 days of chemotherapy. The most common underlying disease was acute lymphoblastic leukemia (68.2%). Time to antibiotic within 60 minutes was reported in 39 episodes (22.9%). The mortality rate was 24%. The length of hospital stays and mortality rate of patients who had time to antibiotic less than 60 minutes was not statistically different than those who had time to antibiotic more than 60 minutes (p-value = 0.33).
Conclusions: The incidence of febrile neutropenia was 5.58 per 1,000 days of chemotherapy. Knowledge of the local distribution of pathogens and their susceptibility patterns and prompt initiation of effective antimicrobial treatment are essential in febrile neutropenia patients.
Downloads
References
Johnston WT, Erdmann F, Newton R, Steliarova-Foucher E, Schüz J, Roman E. Childhood cancer: Estimating regional and global incidence. Cancer Epidemiol 2020:101662.
Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2009; 31: 623-9.
Limvorapitak W, Khawcharoenporn T. Incidence, Risk Factors, and Outcomes of Febrile Neutropenia in Thai Hematologic M a l i g n a n c y P a t i e n t s R e c e i v i n g Chemotherapy: A 6-year Retrospective Cohort Study. Asian Pac J Cancer Prev 2015;16: 5945-50.
Weyl-Ben-Arush M. The Price of the Successful Treatment of Pediatric Malignancies. Curr Pediatr Rev 2017; 13:4-7.
Sung L, Johnston DL. Approach to febrile neutropenia in the general paediatric setting. Paediatr Child Health 2007; 12: 19-21.
Lekshminarayanan A, Bhatt P, Linga VG, et al. National Trends in Hospitalization for Fever and Neutropenia in Children with Cancer, 2007-2014. J Pediatr. 2018; 202:231-37.
Limvorapitak W, Khawcharoenporn T. Incidence, Risk Factors, and Outcomes of Febrile Neutropenia in Thai Hematologic M a l i g n a n c y P a t i e n t s R e c e i v i n g Chemotherapy: A 6-year Retrospective Cohort Study. Asian Pac J Cancer Prev 2015;16: 5945-50.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52: 56-93.
Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol. 2017; 35: 2082-94.
Braga CC, Taplitz RA, Flowers CR. Clinical Implications of Febrile Neutropenia Guidelines in the Cancer Patient Population. J Oncol Pract. 2019; 15: 25-26.
Vathana N, Thitipolpun S, Buaboonnam J, Phuakpet K, Sanpakit K. Prevalence of pathogens in pediatric cancer patient with febrile neutropenia. Southeast Asian J Trop Med Public Health 2017; 48: 151-60.
Traivaree C, Saiwaew A, Lumkul R, Torcharus K. Febrile neutropenia among children with cancer at Phramongkutklao hospital. Royal Thai Army Medical Journal. 2012; 65: 211-18.
Sanpakit K, Phuakpet K, Veerakul G, Narkbunnam N, Chokephaibulkit K. Evaluation of guideline for treatment of febrile neutropenia in pediatric cancer at Siriraj Hospital. J Med Assoc Thai 2005; 88: S124-34.
Noordzij M, Dekker FW, Zoccali C, Jager KJ. Sample size calculations. Nephron Clin Pract 2011; 118: c319-23.
Zimmer AJ, Freifeld AG. Optimal Management of Neutropenic Fever in Patients With Cancer. J Oncol Pract. 2019; 15: 19-24.
Fletcher M, Hodgkiss H, Zhang S, et al. Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer 2013; 60: 1299-306.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
