Changing Microbiological Pattern of Pediatric Febrile Neutropenia

febrile neutropenia (FN) is undoubtedly the commonest emergency in children with malignancy, especially those receiving chemotherapy. Even in this ‘era of antibiotics’ FN continues to be one of the major cause of morbidity and mortality in children with cancer; limiting the gains achieved with the chemotherapeutic agents. febrile neutropenia is defined as a single oral temperature of >38.3˚C (101˚F) or a temperature of >38˚C (100.4˚F) for more than 1 hour with an absolute neutrophil count (ANC) <500/mm3 or an ANC that is expected to decrease to <500/mm3 during the next 48hrs.

Pediatric Febrile Neutropenia
Pediatric Febrile Neutropenia

The risk of infection is related to the duration and severity of neutropenia. The prevalence varies widely and estimated to be 12.8% in children between 1- 9 yrs but increases to 17.4% in those aged 10-19 yrs.Attributes that guides the management considerations in FN include: fever in a neutropenia child is considered to be due to infection unless proved otherwise; microbiological diagnosis is possible in only about 10-30% cases of pediatric FN; Organisms with low virulence or those considered as potential contaminants in an immunocompetent patient can lead to serious infection in presence of neutropenia.

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