Impact of Routine Respiratory Pathogen Panel Test on Outcome of Pediatric Oncology Patients With Febrile Neutropenia

Infection is a significant cause of morbidity and mortality in pediatric oncology patients, especially during neutropenia. While bacterial infections are traditionally considered the primary cause of febrile neutropenia, the growing use of respiratory pathogen panels (RPPs) for viral detection in children has not been extensively studied for its potential beneficial impact on hospital course.

This study aimed to evaluate whether routine respiratory pathogen panel (RPP) testing at admission influences clinical outcomes-including hospital length of stay, duration of neutropenia, fever duration, and PICU transfer-in pediatric oncology patients admitted with febrile neutropenia, and to identify specific respiratory pathogens independently associated with clinical course.

A retrospective cohort study of pediatric oncology patients admitted for febrile neutropenia between April 2010 and December 2022 was conducted at a medium-sized academic center. RPPs were performed on nasal swabs from 196 patients at admission, using molecular-based polymerase chain reaction with results available within 12 h. The panel detected common respiratory viruses and atypical bacteria. Key outcomes-duration of neutropenia, fever, and length of hospital stay, transfer to pediatric intensive care unit (PICU)-were compared between patients who had positive and negative RPP results, respiratory symptoms, and individual pathogens. Viral trends before and after the COVID-19 pandemic were also analyzed.

Viral infections were more prevalent than proven bacterial infections in this cohort. RPP testing, regardless of respiratory symptoms or test positivity, was not associated with significant differences in hospital length of stay or PICU admission. Parainfluenza viruses were associated with shorter neutropenia, fever duration, and hospital stay in univariate analysis. In multivariable logistic regression, detection of community coronaviruses, presence of bacterial infection, and a diagnosis of leukemia were each independently associated with increased odds of prolonged neutropenia, prolonged fever, and longer hospital length of stay.

Routine respiratory pathogen panel testing, in the absence of RPP-guided changes in clinical management, was not associated with reductions in hospital length of stay or overall duration of febrile neutropenia. While identification of specific viral pathogens-such as parainfluenza viruses-was associated with shorter clinical courses, these findings reflect pathogen-specific associations rather than an effect of RPP testing itself. Consequently, this study does not provide sufficient evidence to support the routine use of respiratory pathogen panels in children admitted with febrile neutropenia under current clinical practice.