Study of febrile neutropenia in aplastic anemia and hemato-oncological condition at tertiary care centre

Background: Febrile neutropenia (FN) is a common and potentially life-threatening complication of childhood cancer therapy. Patients with neutropenia are at a higher risk of acquiring infections compared to individuals with normal immune function. In severe cases, absolute neutrophil count (ANC) can be less than 500 per microliter. The aim of this study was to understand the clinical and etiological profile of febrile neutropenia in hemato-oncological and aplastic anemia patients in a tertiary care center in India and to determine the outcome of patients after starting empirical antibiotic therapy. Additionally, we aimed to formulate specific antibiotic therapy based on etiological data from our study.
Methodology: The study was conducted in the pediatric hemato-oncology department of a tertiary care center in India from March 2015 to September 2016. The study included 76 children aged between 1 month and 18 years diagnosed with febrile neutropenia in aplastic anemia and hemato-oncological patients. All febrile neutropenia patients received ceftriaxone and amikacin empirically according to the hospital protocol. Vancomycin was administered additionally to patients who had persistent fever, and fluconazole was initiated empirically in patients in whom fever persisted despite antibiotics on day 4 or 5. In culture-negative and stable patients, intravenous antibiotics were continued for 3 days or until ANC recovered to >500/\(\mu\)l. Bacterial pathogens in all samples yielding culture positivity were identified, and their antibiogram was recorded.
Results: The study found that febrile neutropenia occurs almost equally in all age groups, with a mean age of 6.2 \(\pm\) 4.1 years. Males were predominantly affected, and the mean temperature was 101.7 \(\pm\) 0.7350F. The mean ANC count was 257 \(\pm\) 226.4 neutrophils/mm, and the mean duration of hospital stay was 6.7 \(\pm\) 5.7 days. The respiratory system was the most commonly affected, followed by problems associated with the gastrointestinal tract. In other antibiotic therapies used for our patients empirically or according to the culture sensitivity, we found that the drugs used in decreasing order of frequency were piperacillin-tazobactam (14.4%), vancomycin (11.8%), metronidazole (10.5%), fluconazole (7.9%), meropenem (6.5%), and imipenem (2.6%), while linezolid, ciprofloxacin, and colistin were used in one patient each. Culture reports were positive in a total of 11 (14.5%) patients. No significant difference was found in mean ANC count, but a significant difference was found in the duration of hospital stay between culture-positive and culture-negative patients, with a difference of almost 10 days. The mortality rate was 2.6%.
Conclusion: Males were more commonly affected than females, and most patients presented with symptoms of the respiratory system, followed by the gastrointestinal and urinary tract systems. Most episodes of febrile neutropenia occurred during the induction phase of treatment of acute leukemia, with acute lymphoblastic leukemia being the most common malignancy followed by acute myeloid leukemia. Empirical therapy with ceftriaxone and amikacin leads to a satisfactory clinical outcome in febrile neutropenia. A significant difference was found in the duration of hospital stay between culture-positive and culture-negative patients, with a difference of almost 10 days between the two. The mortality rate in our study was found to be 2.6%.