Neutropenic Children Research Articles

Clinical Profile of Febrile Neutropenia in Children with Hematological Malignancies

Clinical Profile of Febrile Neutropenia in Children with Hematological Malignancies

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

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.

Overcoming challenges to reduce time to antibiotic therapy in febrile neutropenic children: insights from a Mexican center

BackgroundProviding quality supportive therapy for children with cancer is essential to reduce the high mortality rates in low- and middle-income countries. Febrile neutropenia is the most common life-threatening complication of cancer in children. The objective of this study was to evaluate the long-term effectiveness of the ‘Golden Hour’ intervention in reducing the time to administer antibiotics and its impact on clinical outcomes in a Mexican hospital. MethodsA comparative study of children with febrile neutropenia who attended the emergency department at the Hospital Universitario “Dr. José Eleuterio González” was performed between January 2017 and December 2022. In May 2019, this center joined the collaborative ‘Mexico in Alliance with St. Jude’ project. An adapted improvement program was developed based on the implementation of an algorithm comprising institutional guidance, supplies kit, standardization of sample processing, training of healthcare providers, and patient education. The time to antibiotic administration was compared with clinical outcomes between the historical control and post-intervention groups. ResultsA total of 291 patients were included, 122 in the pre-intervention period and 169 in the intervention period. Only 5.7% of the pre-intervention group received the first dose of antibiotics within 60 minutes of presenting to the emergency department compared to 84.6% in the intervention group (p-value <0.000). The median times to antibiotic administration in the pre-intervention and post-intervention periods were 269.4 and 50.54 minutes, respectively (p-value <0.000). Clinical deterioration and admission to the pediatric intensive care unit decreased significantly from 6.6% to 2.3% (p-value = 0.03). ConclusionsSustainability of the quality improvement project ‘Golden Hour’ in low- to mid-income countries demonstrated high effectiveness in reducing time to antibiotic administration among children with febrile neutropenia and improved clinical outcomes over three years of implementation.

Respiratory viral infections in children with cancer and febrile neutropenia and children undergoing hematopoietic stem cell transplantation.

The scope of this review is to understand the epidemiology and potential role of respiratory viral infections in children with cancer and febrile neutropenia, as well as in children, undergoing hematopoietic stem cell transplantation. Early detection of respiratory viral infections through molecular diagnostic techniques has allowed recent randomized clinical studies to advance the possibility of more rational use of antimicrobials in this susceptible population. Progress has been made in the early detection of respiratory viruses in episodes of fever and neutropenia in children with cancer. In selected patients who meet specific clinical safety criteria and have negative bacterial cultures, it has been possible to safely and effectively discontinue antimicrobials. This has been validated in recent randomized clinical studies. However, more evidence is still needed for a similar indication in children, undergoing hematopoietic stem cell transplantation with viral respiratory infection episodes. Understanding the role of respiratory viral infections in populations of immunocompromised children may contribute to a more rational use of antimicrobials and, in the near future, may help to decrease antimicrobial resistance in this susceptible population.

Neutropenia in Childhood-A Narrative Review and Practical Diagnostic Approach.

Neutropenia refers to a decrease in the absolute neutrophil count according to age and race norms and poses a common concern in pediatric practice. Neutrophils serve as host defenders and act crucially in acute inflammation procedures. In this narrative review, we systematically present causes of neutropenia in childhood, mainly adopting the pathophysiological classification of Frater, thereby studying (1) neutropenia with reduced bone marrow reserve, (2) secondary neutropenia with reduced bone marrow reserve, and (3) neutropenia with normal bone marrow reserve. Different conditions in each category are thoroughly discussed and practically approached from the clinician's point of view. Secondary mild to moderate neutropenia is usually benign due to childhood viral infections and is expected to resolve in 2-4 weeks. Bacterial and fungal agents are also associated with transient neutropenia, although fever with severe neutropenia constitutes a medical emergency. Drug-induced and immune neutropenias should be suspected following a careful history and a detailed clinical examination. Cytotoxic chemotherapies treating malignancies are responsible for severe neutropenia and neutropenic shock. Rare genetic neutropenias usually manifest with major infections early in life. Our review of taxonomies clinical findings and associates them to specific neutropenia disorders. We consequently propose a practical diagnostic algorithm for managing neutropenic children.

Evaluation of non-malignant neutropenia in children at tertiary care hospital of South Gujarat

: Neutropenia is defined as absolute neutrophil count &amp;#60;1500cells/mm. This condition is observed in different situations - from a variant of the normal to life-threatening acquired and congenital diseases. Diseases like Tuberculosis, malaria, pertussis, typhoid, dengue, HIV, etc. can cause neutropenia. Mild cases are usually asymptomatic. But severe cases are extremely susceptible to infections, mainly viral infections like CMV, EBV, HIV, etc. Clinical manifestations, like complications, depend on the severity of neutropenia. The clinical manifestations of isolated neutropenia are diverse, including the frequency of infectious episodes. A thorough infectious history of neutropenic patients is the initial step of the evaluation. : To enlist the causes and clinical features, to document various treatment modalities, and to assess the outcome of children with non-malignant neutropenia. : Hospital based prospective cross-sectional study was conducted for 20 months among 42 patients at Department of Pediatrics of tertiary care Hospital. Study was conducted from February 2021 to August 2022. : Total 20 were males and 22 were females. Among the study participants, 36 were &amp;#62;2 years of age and 6 were &amp;#60;2 years of age had nonmalignant neutropenia. Among the study participants, 40 were from urban area and 2 were from rural area. More number of patients had come with chief complaint of fever. : The current population of children in India is close to 1.41 billion and 10.2% of it suffering from neutropenia makes it an important health problem that needs to be thoroughly evaluated.

Non-cancer febrile neutropenia in children: pathogens, antimicrobial susceptibilities, and outcomes

BackgroundFebrile neutropenia is a medical emergency and remains a significant cause of morbidity and mortality, it is defined as a temperature > 38.3 °C (101 °F), or a sustained temperature > 38.0 °C (100.4 °F) for more than 1 h in a neutropenic patient. Neutropenia is defined as a decrease in the absolute number of neutrophils in the blood < 1500 cells/ mm3 in children.Aim of the studyTo identify the specific pathogens causing infections, determine antimicrobial susceptibility, and identify factors associated with morbidity and mortality in febrile neutropenic children.MethodsA prospective cohort study, 38 non-cancerous pediatric patients admitted with 61 febrile episodes, was conducted. Sepsis screen, pan-cultures, and tests to identify the causative pathogens and antimicrobial sensitivity were collected.ResultsCoagulase-negative staphylococci (CONS) infection accounted for 38.4% of all positive cultures, while Klebsiella infection represented 23%. SARS-CoV2 (severe acute respiratory syndrome coronavirus 2) virus infection accounted for 23% of febrile episodes that lead to COVID-19 (coronavirus disease of 2019) sickness; however, it did not significantly impact patients’ outcomes. Unfavorable outcomes were associated with higher C-reactive protein (CRP) levels, positive blood cultures, and gram-negative organisms (p = < 0.001, 0.013, 0.038 respectively). Prolonged duration of fever and elevated CRP levels were significant predictors of poor outcomes in febrile neutropenia, with a sensitivity of 88.9% and 100% and specificity of 70.6% and 62.3%, respectively.ConclusionAmong febrile neutropenic patients, CONS is the most common pathogen, while Klebsiella is the most common gram-negative infection. Gram-positive organisms predominate in bloodstream infections. Prolonged duration of fever and elevated CRP levels can significantly predict poor outcomes.

Neutropenia Occurs More Often Under Carbimazole than Under Methimazole Treatment in Pediatric Graves' Disease Patients.

Background: Agranulocytosis is a rare antithyroid drug treatment (ATD) side effect seen in children suffering from Graves' disease (GD). Neutropenia is a recognized adverse event associated with ATD but has also been reported as pre-treatment neutropenia in GD. Methods: We performed a retrospective cohort study to analyze the longitudinal clinical and biochemical data of 161 pediatric patients with GD who received either methimazole (MMI) or carbimazole (CBZ) as ATD. The inclusion criteria were elevated free thyroxine (fT4 >25 pmol/L), suppressed thyrotropin (TSH <0.05 mlU/mL), and elevated thyrotropin receptor antibodies (TSHRAbs >2.5 IU/L). Absolute neutrophil count (ANC) was used to define neutropenia (ANC <1800/µL) and agranulocytosis (ANC <500/µL). Results: Nine of the 161 patients had neutropenia at diagnosis (ANC: 1348/µL ± 250) without further deterioration under ATD. In this subgroup, we found higher levels of free triiodothyronine (fT3: 31.45 pmol/L ± 3.99) at diagnosis in comparison with those who developed neutropenia (26.29 pmol/L ± 12.96; p = 0.07) and those without neutropenia before and during therapy (23.12 pmol/L ± 13.7; p = 0.003). Thirty-eight patients (23.6%) became neutropenic (ANC: 1479/µL ± 262) while receiving ATD. Neutropenia occurred after a mean of 551.8 (range: 10-1376) days, mostly without further deterioration. Two of these 38 patients developed agranulocytosis and underwent emergency thyroidectomy. The patients with neutropenia were significantly younger (p = 0.031). Neutropenia occurred significantly more often in patients receiving CBZ (50%; n = 20/40) than in those receiving MMI (16.5%; n = 18/110; p = 0.001). The minimum ANC was significantly lower in the CBZ (1971/µL ± 1008) than in the MMI group (2546 ± 959); p = 0.004. Conclusions: Neutropenia occurred significantly more often under CBZ than MMI. As this is potentially due to higher immunogenicity, we suggest that children with GD should be treated with MMI. Frequent measurements of ANC may be needed to detect severe agranulocytosis, although low pre-treatment ANC may not necessarily be a contraindication to ATD treatment. Young age may be potentially associated with an increased risk of reduced ANC. Further investigation is necessary to fully understand risk factors for neutropenia in children with GD.

Safety of empirical antibiotic therapy discontinuing for fever of unknown origin during high-risk neutropenia in children

ECIL-2021 recommends discontinuing empirical antibiotic therapy (EAT) in febrile-neutropenic children after 72h of treatment and at least 24-48h of apyrexia in the case of fever of unknown origin (FUO). These guidelines are rarely applied to high-risk children's neutropenia. We retrospectively included all consecutive FUO episodes occurring during profound neutropenia ≥10 days in children in our institution. We evaluated the safety of EAT discontinuation in patients for whom the ECIL guidelines were followed compared to those for whom they didn't. We used a combined criterion of mortality and intensive care unit admission at 30 days. We identified risk factors for recurrent fever after EAT discontinuation. Fifty-one FUO episodes occurred in 37 patients. EAT discontinuation followed ECIL guidelines in 19 (37%) episodes. No deaths and-or transfers in ICU occurred in the ECIL group. The duration of EAT was shorter by nine days in the group following ECIL guidelines (p<0.001). We observed 14 (27%) episodes of recurrent fever. Mucositis was significantly associated with recurrent fever (p<0.01). EAT discontinuation seems feasible and safe in FUO during prolonged febrile neutropenia in children. However, mucosal lesions should prompt thorough surveillance due to the risk of recurrent fever.

The role of proangiogenic cytokines in predicting sepsis in febrile neutropenic children with cancer.

We assessed the relationship between sepsis occurrence and the serum levels of angiopoietin (Ang-1, Ang-2), vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pediatric patients with cancer-related febrile neutropenia. Fifty-two children with malignant tumors who experienced 86 episodes of febrile neutropenia (FN) were examined between June 2016 and June 2018. Each FN episode was considered a separate event and the total number of FNs were recorded (86 FN episodes = FN group). The control group consisted of 21 healthy children. Ang-1, Ang-2, VEGF-A and sFlt-1 were measured at the baseline and 48th hour of each FN episode -alongside routine characterization of inflammation (C-reactive protein; white blood cell and absolute neutrophil count). Among the episodes, 29 (34.5%) developed sepsis while 57 were classified as non-complicated FN. The baseline values of patients and controls were significantly different for Ang-1, Ang-2, VEGF and sFlt-1 values (all, p < 0.05). In the subgroup with sepsis, Ang-2 values were higher than in the subgroup without sepsis (p = 0.017). In predicting sepsis, Ang-2 had 60.7% sensitivity and 66.7% specificity at the 74.6 cut-off value (AUC: 0.662 [95%CI: 0.541 - 0.783], p = 0.022), Ang-2 / Ang-1 ratio had 65.5% sensitivity and 60.0% specificity at the 0.405 cut-off value (AUC: 0.633 [95%CI: 0.513 - 0.753], p = 0.046). Our results reveal that Ang-2 and Ang-2/Ang-1 were higher in the sepsis group and Ang-2 might be a biomarker to indicate the risk of sepsis in patients with FN and/or cancer.

Analysis of bacteremia at first-line antibiotic treatment for febrile neutropenia in children and adolescents: A retrospective, single-center analysis

BackgroundControl of bacterial and fungal infections is critical to improving outcomes in hematological neoplastic diseases of children and adolescents. In this study, a retrospective analysis of our previous studies on febrile neutropenia was performed to investigate bacteremia. ProcedureFrom August 2008 to December 2023, five antibiotic studies were performed for febrile and neutropenic pediatric patients who had been treated with chemotherapy, immunosuppressive therapy, or had received stem cell transplantation in the pediatric unit at Sapporo Hokuyu Hospital. The rate of positive blood culture, detected bacteria, and susceptibility of several types of antibiotics in febrile episodes were investigated. ResultsBlood culture was positive in 133 of 1604 febrile episodes of 329 patients. Detected bacteria were Gram-positive cocci (61.2 %), Gram-negative bacilli (27.6 %), Gram-negative cocci (0.7 %), and Gram-positive bacilli (10.4 %). The incidence of bacteremia over time showed a decreasing trend with each passing year. In particular, the incidence of bacteremia was around 10 % in 2008–2013, whereas it was often below 5 % after 2020; this decrease was statistically significant. Although almost all detected bacteria and their susceptibilities to antibiotics (piperacillin/tazobactam, meropenem, ceftazidime, and cefozopran) did not change over time, all Escherichia coli detected after 2014 were extended-spectrum β-lactamase-producing bacteria.

Malnutrition as a predictor of adverse outcomes of febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition impairs immune function, leading to increased incidence of infection, poor quality of life, as well as death. Febrile neutropenia (FN) has a high prevalence in children with acute lymphoblastic leukemia (ALL) and a poor outcome as well. Methods: This prospective observational study was done in the department of pediatrics hematology and oncology (PHO), BSMMU, from January 2021 to October 2021. A total of 60 patients of ALL were selected purposively. Patients were evaluated by taking anthropometric parameters before getting chemotherapy and were prospectively followed up for the development and outcome of FN until recovery. Statistical analysis was performed by using SPSS (Statistical package for the social sciences) for Windows version 26.0. Result: Analysis of nutritional status as a risk factor for FN based on anthropometric indices, was found statistically significant for, weight for height (≤5 years) p=0.036, OR=0.24 (95% CI= 0.06-0.958), weight for age p=0.006, OR=0.23 (95% CI=0.07-0.67), but for BMI for age (&gt;5 years) p=0.28, OD=0.28 (95% CI=0.02-3.19), and height for age p=0.513, OD=0.66 (95% CI=0.18-2.33) no statistically significant value was found. In this study, we found mortality rate was 15%. The mortality rate was significantly worse (27.3%) for patients who were malnourished at diagnosis as compared to those who were well nourished (7.9%) at diagnosis. Conclusions: FN and its complications are more common in malnourished children with ALL. Malnutrition is associated with adverse outcomes of FN in children with ALL.

Microbiologically Documented Infection-related Mortality in Children with Acute Leukemia: A Single-center Experience

Infections are a significant cause of morbidity and mortality of chemotherapy-induced neutropenia in children with acute leukemia. The aim of this study was to evaluate microbiologically documented infections (MDIs) during febrile neutropenia (FN) episodes and their relation to mortality. Four hundred eighty-seven FN episodes of 140 children were enrolled in this single-center study, and MDI in those FN episodes was retrospectively examined. Eighty-four patients (60%) had at least one positive peripheral blood, central line, or urine culture. MDIs were detected in 163 of 487 (33.4%) FN episodes of 84 children with leukemia. Gram-negative bacteria, Gram-positive bacteria, and fungal agents were isolated in 52.7%, 40.4%, and 6.9% of whole episodes. Coagulase-negative Staphylococci and Enterococci were the most detected Gram-positive bacteria. Klebsiella spp. and Escherichia coli were the most common Gram-negative bacteria isolated in the entire cohort. A central line was present in 145 MDI episodes, and catheter removal was required in 35 cases (17.7%) due to infection with Gram-negative bacteria, Gram-positive bacteria 43%, 28.5%, and fungus 28.5%, respectively. MDI-related mortality was 9.8%. The highest mortality rate (16.7%) was observed in Gram-negative bacteria and patients with relapsed and resistant leukemia. The most common infectious agent related to mortality was Klebsiella (31%). Resistance to third- or fourth-generation cephalosporins in Gram-negative bacteria was found to be over 50% of our cohort uri. Empirical antibiotic therapy at the onset of FN in neutropenic patients is crucial; therefore, the institution’s predominant pathogens and resistance patterns should guide the choice of empirical antimicrobials. To reduce mortality and morbidity, each center should know its local epidemiological data and antibiotic susceptibility.

Assessment of the management and outcome of neutropenia in paediatric haemato-oncology inpatients at Kenyatta National Hospital

Background: Neutropenia is a common complication among the haemato-oncology pediatric patients. Children who develop such complications are prone to bacterial infections which further predispose them to death. This study aimed at improving the practice of management of neutropenia in children with the view of reducing pediatric haemato-oncology mortality. Methods: We retrospectively reviewed medical records of paediatric haemato-oncology inpatients aged 13 years and below, who developed neutropenia during treatment at Kenyatta National Hospital. A data abstraction form was used to collect data from 113 medical records of patients admitted between 1st January 2020 and 31st December 2020. Data were analyzed using R to obtain descriptive and inferential statistics using a 95% confidence interval. Results: Boys constituted most of the cases assessed. The median (IQR) age at admission was 6 (4, 10) years. Leukaemias were more common than lymphomas. Acute lymphocytic leukaemia (59%) and Hodgkin’s lymphoma (4%) were the most and least frequently diagnosed haemato-oncology cancers. Most patients were diagnosed during the induction stage, 47 (42%) and had febrile neutropenia 59 (52%). Vaccination and bone marrow suppression histories were poorly documented. Thirty-three (29%) patients were reported to have succumbed during their treatment. G-CSF prescription was statistically significantly associated (p=0.045) with the survival status (death or alive) of patients, particularly at the induction stage (p=0.007). Conclusions: Neutropenia management in KNH is done as per protocol, with room to improve on history taking. Although 29% of the children succumbed within the course of treatment, the majority (71%) of the patients were discharged.

Time to Antibiotics (TTA) - Reassessment from the German Working Group for Fever and Neutropenia in Children and Adolescents (DGPI/GPOH)

The current German guidance from 2016 recommends a Time to Antibiotics (TTA) of<60 min in children and adolescents with febrile neutropenia (FN). Critical analysis of available studies and recent meta-analyses, and discussion of the practical consequences in the FN working group of the German Societies for Paediatric Oncology and Haematology and Paediatric Infectious Diseases. The available evidence does not support a clinically significant outcome benefit of a TTA<60 min in all paediatric patients with FN. Studies suggesting such a benefit are biased (mainly triage bias), use different TTA definitions and display further methodical limitations. In any case, a TTA<60 min remains an essential component of the 1st hour-bundle in paediatric cancer patients with septic shock or sepsis with organ dysfunction. Provided that all paediatric FN patients receive a structured medical history and physical examination (including vital signs) by experienced and trained medical personnel in a timely fashion, and provided that a sepsis triage and management bundle is established and implemented, a TTA lower than 3 hours is sufficient and reasonable in stable paediatric cancer patients with FN.

Identifying Risk Factors and Improving Preventive Strategies for Febrile Neutropenia in Children with Leukemia Receiving Ciprofloxacin Prophylaxis.

The purpose of this study was to identify risk factors and improve preventive strategies for febrile neutropenia (FEN) in children with leukemia who were receiving ciprofloxacin prophylaxis. The study included 100 children with leukemia (n=80 with acute lymphoblastic leukemia (ALL) and n=20 with acute myeloblastic leukemia) (AML). Patients were divided into two groups based on whether they had three or fewer three FEN episodes [Group 1] or more than three FEN episodes [Group 2]. Group 1 had 63 (63%) of the 100 patients, while Group 2 had 37 (37%). Older age (≥7 years), leukemia type (AML), prolonged neutropenia (>10 days), the presence of neutropenia, and hypogammaglobulinemia at diagnosis were all risk factors for more than three FEN episodes. Our findings suggest that, in addition to ciprofloxacin prophylaxis, identifying risk factors and improving preventive strategies could help reduce FEN in children with leukemia.

Etiology and Factors Affecting Severe Complications and Mortality of Febrile Neutropenia in Children with Acute Leukemia

Febrile neutropenia (FN) is an important complication that causes high rates of morbidity and mortality in patients with malignancies. We aimed to investigate the etiology, epidemiological distribution and its change over the years, clinical courses, and outcomes of FN in children with acute leukemia. We retrospectively analyzed the demographic data, clinical characteristics, laboratory results, severe complications, and mortality rates of pediatric patients with FN between January 2010 and December 2020. In 153 patients, a total of 450 FN episodes (FNEs) occurred. Eighty-four (54.9%) of these patients were male, the median age of the patients was 6.5 (range: 3-12.2) years, and 127 patients (83%) were diagnosed with acute lymphoblastic leukemia. Fever with a focus was found in approximately half of the patients, and an etiology was identified for 38.7% of the patients. The most common fever focus was bloodstream infection (n=74, 16.5%). Etiologically, a bacterial infection was identified in 22.7% (n=102), a viral infection in 13.3% (n=60), and a fungal infection in 5.8% (n=26) of the episodes. Twenty-six (23.2%) of a total of 112 bacteria were multidrug resistant (MDR) The rate of severe complications was 7.8% (n=35) and the mortality rate was 2% (n=9). In logistic regression analysis, refractory/relapsed malignancies and high C-reactive protein (CRP) at first admission were found to be the most important independent risk factors for mortality. Prolonged neutropenia after chemotherapy, diagnosis of acute myeloid leukemia, identification of fever focus or etiological agents, invasive fungal infections, polymicrobial infections, and need for intravenous immunoglobulin treatment increased the frequency of severe complications. We found that there was no significant change in the epidemiological distribution or frequency of resistant bacteria in our center in the last 10 years compared to previous years. Prolonged duration of fever, relapsed/refractory malignancies, presence of fever focus, and high CRP level were significant risk factors for poor clinical course and outcome.

Identifying Risk Factors and Improving Preventive Strategies for Febrile Neutropenia in Children with Leukemia Receiving Ciprofloxacin Prophylaxis

The purpose of this study was to identify risk factors and improve preventive strategies for febrile neutropenia (FEN) in children with leukemia who were receiving ciprofloxacin prophylaxis. The study included 100 children with leukemia [n=80 with acute lymphoblastic leukemia and n=20 with acute myeloblastic leukemia (AML)]. Patients were divided into two groups based on whether they had three or fewer FEN episodes (Group 1) or more than three FEN episodes (Group 2). Group 1 contained 63 (63%) of the 100 patients, while Group 2 contained 37 (37%). Older age (≥7 years), leukemia type, prolonged neutropenia (>10 days), and the presence of neutropenia and hypogammaglobulinemia at diagnosis were all risk factors for having more than three FEN episodes. Our findings suggest that, in addition to ciprofloxacin prophylaxis, identifying risk factors and improving preventive strategies could help reduce FEN episodes in children with leukemia.

Lenfoma ve Solid Tümörlü Çocuklarda Febril Nötropenide Sefaperazon-Sulbaktam Monoterapisinin Etkinliği

Objective: Monotherapy with a beta lactam or a cephalosporin has become the standard of care for the treatment of febrile neutropenia (FEN). We aimed to evaluate the efficacy of cefoperazone/sulbactam (CS) as empirical monotherapy for febrile neutropenia in children with solid tumors and lymphomas. Material and Methods: Children with FEN received cefaperazone-sulbactam (80 mg/kg/day, every 8 hours). Treatment responses (a) successful, complete resolution of all signs and symptoms of infection at 72 hours and after 7 days of CS treatment; (b) success with modification, change of therapy for viral, parasitic or fungal infection or addition of glycopeptides; (c) failure was defined as the emergence of a new or resistant infection, treatment-resistant bacteremia, the need to switch to carbapenems. Results: Our study included 157 patients and 350 febrile neutropenia episodes. The most common diagnoses were osteosarcoma (35%), Ewing sarcoma (30%), non-hodgkin lymphoma (13%) and rhabdomyosarcoma (9%), respectively. The origin of fever could not be determined in 223 (64%) of FEN episodes, 79 (22%) had microbiologically documented infection (MDI), and 48 (14%) had clinically documented infection (CDI). The success rate was 65% (229), the success rate with modification was 9% (31) and the failure rate was 26% (90). SC monotherapy was successful in 33% of attacks with MDI and in 60% of attacks with CDI. However, SC monotherapy was successful in 82% of febrile episodes of unknown origin. Conclusion: Cefoperazone/sulbactam is effective and safe in febrile neutropenic children with solid tumors and lymphomas for monotherapy.

Serial Blood Cultures in Neutropenic Children with Persistent Fever After Conventional Chemotherapy in Bangladesh: Their Usefulness

When the initial blood culture reveals no bacterial growth, the primary goal of the study is to ascertain the prevalence of bacteremia in patients admitted with febrile neutropenia and to assess patient risk factors for this occurrence. A prospective cross-sectional study was conducted. 90 children with febrile neutropenia who are being treated at Bangabandhu’s Paediatrics, Hemato-Oncology Department will participate in the trial. Medical Sheikh Mujib Medical University, during the period of July’22 to December’22. Data will be collected in a questionnaire with informed written consent. Data will be presented in graph and probability values of &lt;0.05 will be considered as statistically significant for all results. Admitted patients were selected with purposive sampling technique the primary end point was to assess the blood bacterial isolates in patients with febrile neutropenia. The mean age was found 6.9±3.1 years with range from 2.5 years to 15 years. About the diagnosis, more than half of the patients patients had ALL diagnosis followed by AML and then NHL diagnosis (p = 0.043). The mean duration of neutropenia was found 10.8±6.67 days with rang from 3 to 30 days. The 2 times mean number of episode fever was found 1.2±0.4 time varied from Regarding the blood culture islolates, growth was not found in 2nd sample and 3rd sample.