Diagnosis and Management of Febrile Neutropenia in Pediatric Oncology Patients-A Systematic Review

Abstract

Infectious diseases are associated with a high morbidity and mortality rate among pediatric cancer patients undergoing treatment or receiving a transplant. Neutropenia represents a potentially fatal complication of cancer treatment and is associated with a high risk of developing bacterial infections. Although febrile neutropenia (FN) can affect both adults and children, the latter has a higher chance of infections with an unknown origin. Prompt empiric broad-spectrum antibiotic administration is collectively considered the best therapeutic approach. This review aims to analyze the latest works from the literature regarding the therapeutic strategies, schemes, and approaches and the efficacy of these in pediatric febrile neutropenia. Following PRISMA guidelines, an advanced search on PubMed, Scopus, and Cochrane Library, using the keywords "febrile neutropenia", "pediatric", "cancer", and "oncology", was performed. A total of 197 articles were found to be eligible. After screening the abstracts and excluding unfit studies, 16 articles were analyzed. There were eight retrospective studies, five prospective studies, and two clinical trials. Altogether, these studies have described around 5000 episodes of FN. The median age of the participants was 7.6 years, and the underlying condition for most of them was acute leukemia. The infectious agent could only be determined in around one-fifth of cases, from which 90% were of bacterial origin. As such, empirical broad-spectrum antibiotics are used, with the most used treatment scheme comprising third- and fourth-generation cephalosporins and antipseudomonal penicillins. In order to improve the treatment strategies of FN episodes and to successfully de-escalate treatments toward narrower-spectrum antibiotics, hospitals and clinics should increase their efforts in identifying the underlying cause of FN episodes through blood culture urine culture and viral tests, wherever infrastructure enables it.

Keywords: broad-spectrum antibiotics; febrile neutropenia; pediatric oncology.

Figure 1

PRISMA flowchart for the selection process.

Figure 2

Pathogens involved in the microbiologically documented infections.

Figure 3

Individual look upon the pathogens involved in the MDIs: Alali M. et al. (2020) [13]; Suttitossatam I. et al. (2020) [15]; Janssens K.P. et al. (2020) [4]; Lee N.H. et al. (2020) [16]; Kamonrattana R. et al. (2019) [19]; Reinecke J. et al. (2018) [22]; Kobayashi R. et al. (2020) [23]; Fortino S.S. et al. (2019) [24]; Raad C. et al. (2021) [25].