Evaluation of Febrile Episodes in Children With or Without Neutropenia Undergoing Chemotherapy

This study aims to analyze the clinical and microbiologic characteristics of febrile episodes in pediatric oncology patients undergoing chemotherapy, with and without neutropenia.

A retrospective analysis was conducted on 212 febrile episodes in 94 pediatric cancer patients hospitalized between January 2015 and December 2018. Patients with fever ≥38°C were included. Data were extracted from electronic health records. Infection diagnoses were established based on clinical examination and microbiologic studies.

Among the 212 febrile episodes, 117 (55.1%) were classified as febrile neutropenia. Infection foci were identified in 51.4% of cases, with catheter infections being the most common (18.4%), followed by viral upper respiratory tract infections (16%). Microbiologic analysis identified bacterial agents in 69 cases. The most frequently identified bacteria were Coagulase-negative Staphylococcus and Escherichia coli. Septic shock occurred in 7 febrile episodes (3.3%), all in neutropenic patients. There was no statistically significant difference in infection rates between neutropenic and non-neutropenic groups (P>0.05), except for septic shock, which was significantly higher in neutropenic patients (P=0.02).

Our data suggest that infections remain a major cause of morbidity in pediatric oncology patients regardless of neutropenic status. We believe that prospective and multicenter studies are also necessary to optimize infection management strategies in non-neutropenic patients with fever as well as neutropenic ones.