Related Experiment Videos
Infection risk factors in febrile, neutropenic children and adolescents
G R Jones1, G K Konsler, R P Dunaway
1Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, USA.
Abstract:
We studied 276 fever episodes with an absolute neutrophil count (ANC) < 500/mm3 to determine patient characteristics predicting serious infection. Infections occurred in 38% of patients. Blood cultures were positive in 58% of documented infections. There was no difference in the rates of infection or positive blood culture when ANC was < 200/mm3 compared with a higher ANC. However, certain high risk infections were more common with an ANC < 200/ mm3. Leukemia patients had more infections compared with other groups. Serious infections were more common during induction therapy or relapse. Infection incidence varied significantly with patient age and onset of fever in the inpatients. Less than one fifth of febrile neutropenic episodes had no risk features for serious infection. We conclude that several clinical characteristics correlate with serious infection in febrile, neutropenic children and adolescents receiving modern supportive care. Despite improvements in supportive care measures, most febrile, neutropenic patients need close observation and empiric intravenous antibiotic therapy.
Insights
Identifying serious infections in febrile neutropenic children is crucial. Certain patient factors, like leukemia or specific treatment phases, increase infection risk, necessitating close monitoring and prompt antibiotic treatment.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Febrile neutropenia is a common oncologic emergency in children.
- Prompt identification of serious infections is critical for patient outcomes.
- Modern supportive care has improved outcomes but risk stratification remains essential.
Purpose of the Study:
- To identify patient characteristics that predict serious infection in children and adolescents with fever and neutropenia.
- To evaluate the relationship between absolute neutrophil count (ANC) levels and infection rates.
- To inform clinical management strategies for febrile neutropenic episodes.
Main Methods:
- Retrospective analysis of 276 episodes of fever with an absolute neutrophil count (ANC) < 500/mm3.
- Correlation of patient demographics, underlying diagnoses, treatment status, and fever characteristics with the incidence of serious infection.
- Analysis of blood culture positivity rates in documented infections.
Main Results:
- Serious infections occurred in 38% of patients.
- No significant difference in infection rates or blood culture positivity was observed between ANC < 200/mm3 and higher ANC groups.
- High-risk infections were more frequent with ANC < 200/mm3.
- Leukemia patients, those undergoing induction therapy or relapse, and variations in patient age and fever onset were associated with increased infection incidence.
Conclusions:
- Clinical characteristics, including underlying diagnosis and treatment phase, significantly correlate with serious infection risk in febrile neutropenic pediatric patients.
- Despite advancements in supportive care, most febrile neutropenic episodes require vigilant observation and empiric intravenous antibiotic therapy.
- ANC thresholds alone may not fully capture the risk for serious infection, highlighting the importance of comprehensive clinical assessment.