Risk Factors for Microbiologically-documented Infections, Mortality and Prolonged Hospital Stay in Children with Febrile Neutropenia

ABSTRACT

Objective: To analyze the risk factors for microbiologicallydocumented infection, mortality and hospital stay more than 5days in children with febrile neutropenia.Design: Cross-sectional study (July 2013-September 2014).Setting: Government-run, tertiary-care, university hospital inChandigarh, Northern India.Participants: 414 episodes in 264 children aged <12 years, notundergoing stem-cell transplantation.Outcome measures: Predictors for ‘high-risk’ febrileneutropenia.Results: Microbiologically-documented infections wereobserved in 82 children (19.8%); bacterial 14.2%, fungal 4.3%,polymicrobial 9.7%. Complications were documented in 109(26%) children. 43 (10.3%) died 8 due to fungal and 35 due tobacterial sepsis. Children admitted within 7 days of the lastchemotherapy (P<0.01) and having a non-upper respiratory focusof infection (P<0.02) were at risk of developing microbiologically-documented infections and death. Platelet count <20000/uL(P=0.03) was an additional predictor for microbiologically-documented infections, while albumin <2.5 g/dL (P=0.04) and C-reactive protein >90 mg/L (P=0.02) were risk factors predictingmortality. The median (IQR) duration of hospital stay was 5 (3,8)days. Hospital stay >5 days was seen in 144 (35%) children.Children with acute myeloid leukaemia (P<0.01) and admittedwithin 7 days of chemotherapy (P=0.02) were likely to have aprolonged hospital stay >5 days.Conclusions: Febrile neutropenicchildren admitted within 7days of completion of chemotherapy, those with a non-upperrespiratory focus of infection, CRP >90 mg/dL, platelet <20000/uLand albumin <2.5 g/dL need to be considered as ‘high risk’ forcomplications and mortality.