Fever and neutropenia in children with neoplastic disease: an analysis of 158 episodes

Abstract

The development of fever in neutropenic cancer patients is frequently an indication of infection. The response of these patients to antibiotic treatment is often poor, and the recent literature continues to document a substantial mortality rate in spite of the prompt treatment of these patients with multiple-agent antibiotic therapy. Because of limited available information regarding fever and neutropenia in pediatric cancer patients, we undertook an analysis of a group of such patients from a pediatric oncology center. The incidence of probable and documented infections was 39.2% in a group of these patients, representing 158 febrile episodes. The most frequent form of infection was bacterial sepsis; pulmonary infections were the next most frequent, followed by infections of skin and soft tissues. In leukemia patients with culture-proven infections, gram-negative organisms were isolated in 61.1% of episodes while gram-positive organisms were isolated in 41.7%. Escherichia coli and Staphylococcus aureus were the organisms most frequently isolated from these patients. In solid-tumor patients with bacterial infections, gram-positive organisms were isolated in 78% of cases. Patients having the highest incidence of documented infections were those with leukemia who had active disease (induction or relapse), and severe neutropenia (less than 200 granulocytes/microliter). Antibiotic therapy with cephalothin, gentamicin, and carbenicillin (CGC), was effective in 41 of 45 (91.1%) episodes of documented infection in the total group of patients.