Contributions
Abstract: EP834
Type: E-Poster Presentation
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Infections in pediatric cancer patients are the major reasons for morbidity and mortality. In cases of malignant diseases, fever may herald an upcoming life-threatening situation. This study tried to unleash few mysterious interrogation points about the nature of febrile neutropenic episodes in children.
Aims
To assess the overall and attributable mortality from febrile neutropenia and to evaluate the susceptibility pattern to antimicrobials in febrile neutropenia.
Methods
A prospective non-interventional observational study. All consecutive pediatric inpatients affected by haematological diseases or solid tumours who were admitted at the pediatric oncology unit in Children Welfare Teaching Hospital / Medical City, with fever and neutropenia (Absolute Neutrophile count (ANC) <500/cmm) or developed fever and neutropenia during hospitalization were enrolled into the study until hospital discharge or death, started from September 1st 2019 till February 29th 2020. The total number of patients admitted to the pediatric oncology unit was 207 patients, with a total of 350 neutropenic episodes.
Results
The majority of reported underlying diagnoses belong to hematological malignancies in 236 patients (67.4%). Acute lymphoblastic leukemia was reported to be the most frequent in 197 episodes (56.3%), followed by acute myeloid leukemia in 39 episodes (11.1%), then neuroblastoma (6.3%), and brain tumors (5.1%). Forty percent of patients recalled or had shown respiratory symptoms. Abdominal complaints were reported in 178 patients (50.9%). Bleeding was recorded in 79 patients (22.6%). Mucositis was noted in 187 patients (53.4%), grade II being the most frequently notified in 83 patients (44.4%). Performance score according to Eastern cooperative oncology group showed that the majority have a score of II (48.4%). At time of admission, the mean WBC count 3,100 /cmm, and the mean ANC was 140 with a range of (0 – 500). Blood was withdrawn for culture and sensitivity at time of admission; Sixty-one episodes showed positive bacterial growth (18.2%), while 274 showed no growth (81.8%). The growth showed gram-positive bacteria in two-third of episodes (65.6%), while gram-negative was shown in one-third (34.4%). The majority of patients (84.0%) belong to high-risk febrile neutropenia, while fifty-six patients (16.0%) were low-risk patients. Out of the group, 46.4% were labelled as fever without origin as the final diagnosis, while 34.0% with a presumptive ‘clinical infection’ diagnosis. Microbiological diagnoses were reported in 68 patients; 61 blood, 2 skin, 2 sputum, 2 urine, and 1 ear. Out of the group, 21 patients (6.0%) died as a complication of febrile neutropenia. The mean duration of fever before admission for the deceased group was 9.1 days which was significantly longer than the duration for the alive group (mean duration 3.0 days). There was a significant statistical correlation between the fate of the patients and the following parameters: type of malignancy, phase of disease, and treatment lines.
Conclusion
Conclusion: Acute lymphoblastic leukemia was the most frequently encountered underlying malignancy, acute myeloid leukemia was associated with the worst outcome. The result of blood cultures was comparable to worldwide results. Gram positive organisms were the most commonly identified growth. High-risk febrile neutropenia was the commonest reported type, low-risk being lowest because of possible treatment outside the hospital on oral-based antibiotics. Finally, infection related mortality was high.
Keyword(s): Cancer, Children, Fever, Neutropenia
Abstract: EP834
Type: E-Poster Presentation
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Infections in pediatric cancer patients are the major reasons for morbidity and mortality. In cases of malignant diseases, fever may herald an upcoming life-threatening situation. This study tried to unleash few mysterious interrogation points about the nature of febrile neutropenic episodes in children.
Aims
To assess the overall and attributable mortality from febrile neutropenia and to evaluate the susceptibility pattern to antimicrobials in febrile neutropenia.
Methods
A prospective non-interventional observational study. All consecutive pediatric inpatients affected by haematological diseases or solid tumours who were admitted at the pediatric oncology unit in Children Welfare Teaching Hospital / Medical City, with fever and neutropenia (Absolute Neutrophile count (ANC) <500/cmm) or developed fever and neutropenia during hospitalization were enrolled into the study until hospital discharge or death, started from September 1st 2019 till February 29th 2020. The total number of patients admitted to the pediatric oncology unit was 207 patients, with a total of 350 neutropenic episodes.
Results
The majority of reported underlying diagnoses belong to hematological malignancies in 236 patients (67.4%). Acute lymphoblastic leukemia was reported to be the most frequent in 197 episodes (56.3%), followed by acute myeloid leukemia in 39 episodes (11.1%), then neuroblastoma (6.3%), and brain tumors (5.1%). Forty percent of patients recalled or had shown respiratory symptoms. Abdominal complaints were reported in 178 patients (50.9%). Bleeding was recorded in 79 patients (22.6%). Mucositis was noted in 187 patients (53.4%), grade II being the most frequently notified in 83 patients (44.4%). Performance score according to Eastern cooperative oncology group showed that the majority have a score of II (48.4%). At time of admission, the mean WBC count 3,100 /cmm, and the mean ANC was 140 with a range of (0 – 500). Blood was withdrawn for culture and sensitivity at time of admission; Sixty-one episodes showed positive bacterial growth (18.2%), while 274 showed no growth (81.8%). The growth showed gram-positive bacteria in two-third of episodes (65.6%), while gram-negative was shown in one-third (34.4%). The majority of patients (84.0%) belong to high-risk febrile neutropenia, while fifty-six patients (16.0%) were low-risk patients. Out of the group, 46.4% were labelled as fever without origin as the final diagnosis, while 34.0% with a presumptive ‘clinical infection’ diagnosis. Microbiological diagnoses were reported in 68 patients; 61 blood, 2 skin, 2 sputum, 2 urine, and 1 ear. Out of the group, 21 patients (6.0%) died as a complication of febrile neutropenia. The mean duration of fever before admission for the deceased group was 9.1 days which was significantly longer than the duration for the alive group (mean duration 3.0 days). There was a significant statistical correlation between the fate of the patients and the following parameters: type of malignancy, phase of disease, and treatment lines.
Conclusion
Conclusion: Acute lymphoblastic leukemia was the most frequently encountered underlying malignancy, acute myeloid leukemia was associated with the worst outcome. The result of blood cultures was comparable to worldwide results. Gram positive organisms were the most commonly identified growth. High-risk febrile neutropenia was the commonest reported type, low-risk being lowest because of possible treatment outside the hospital on oral-based antibiotics. Finally, infection related mortality was high.
Keyword(s): Cancer, Children, Fever, Neutropenia