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

Abstract

Abstract Background Febrile 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 study To identify the specific pathogens causing infections, determine antimicrobial susceptibility, and identify factors associated with morbidity and mortality in febrile neutropenic children. Methods A 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. Results Coagulase-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. Conclusion Among 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.