Clinical Characteristics and Outcomes of Non-Neutropenic Fever in Children with Cancer: An Urban-Single Institution Experience

Name: Oranooj Lertkovit

Organization : Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University

keyword: cancer

; chemotherapy

; fever

; non-neutropenic fever

; pediatric

Abstract: OBJECTIVE: To evaluate the clinical characteristics and outcomes of pediatric cancer with non-neutropenic fever (NNF) in pediatric cancer patients in the absence of a central venous catheter. METHODS: This single-center retrospective cohort study enrolled pediatric patients with cancer (age < 18 years) who received chemotherapy treatment at the Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from January 2016 to July 2020. Clinical characteristics and outcomes of NNF episodes were described. Descriptive statistics were analyzed. RESULTS: Fifty-one patients were reviewed, but the 97 NNF episodes were documented from 32 patients. Only One (of the 51 patients) had subcutaneous port. The most frequent cancer diagnosis was acute lymphoblastic leukemia (51%). NNF occurred in 3.8 per 1,000 days of chemotherapy period (95% confidence interval [CI] 3.1–4.6). The most frequently clinically documented infections were respiratory tract infection (35%), urinary tract infection (11%), and gastrointestinal infection (10%). The causative pathogens could not be demonstrated in 67.1% of NNF episodes. The commonly identified pathogens were viruses (12.3%), gram-negative bacteria (10.3%), and gram-positive bacteria (5.2%). Empiric treatment with antibiotic was initiated in 92.8% of the total episodes. Ceftriaxone was the most common antibiotic of choice. Only one episode had a positive hemoculture. Four (4.1%) episodes required intensive care unit admissions, and only one NNF-related mortality due to the human Bocavirus pneumonia and multi-organ failure occurred. The mortality rate of NNF was 3.1%. CONCLUSION: NNF episodes are common and life-threatening complications among pediatric cancer patients and generally lead to hospitalization. The incidence of NNF was 3.8 per 1,000 days of chemotherapy (95% CI 3.1–4.6). The causative pathogen in 67% of NNF episodes was unknown, and the commonly identified pathogens were viruses. However, many patients did not identify any causative bacteria, and they received intravenous antibiotics and were hospitalized. The results of our study suggest that patients with severe symptoms may indicate early evaluation and prompt management for viral infection, especially in a patient with a negative bacterial culture and poor respond to antibiotic treatment. This study reveals baseline information for future cohorts to provide guideline management of this common complication during cancer treatment.

ห้องสมุดมหาวิทยาลัยนวมินทราธิราช

Address: กรุงเทพมหานคร

Email: nmu_library@nmu.ac.th

Name: Daranee Isaranimitkul

Role: Navamindradhiraj University

Name: Taweewong Tantracheewathorn

Role: Navamindradhiraj University

Created: 2023

Modified: 2024-02-12

Issued: 2566-10-05

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BibliograpyCitation : Vajira Med J 2023; 67(2) Apr-Jun: 519-526

Vajira Medical Journal: Journal of Urban Medicine (Vajira Med J)

tha

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