Relationship Between Risk Factors, Causative Microorganisms, and Prognosis in Pediatric Patients with Neutropenic Fever

Abstract

Objective: Febrile neutropenia (FN) is a major cause of morbidity and mortality in children with hematological malignancies and requires prompt empirical antimicrobial therapy. The study aimed to evaluate clinical characteristics, laboratory findings, microbiological profiles, treatment responses, and outcomes of FN episodes in pediatric patients. Materials and Methods: A retrospective review of 397 FN episodes in 88 children aged 0–18 years treated at Baskent University Hospital was conducted. Clinical findings, laboratory parameters, and microbiological results were analyzed to identify causative organisms and predictors of adverse outcomes. Results: Secondary FN episodes were more likely to persist for seven days or longer and required modification of empirical antibiotic therapy more frequently than primary episodes. Thrombocytopenia, low absolute monocyte counts, and elevated total and direct bilirubin levels were observed more commonly during secondary episodes. Clinically documented infections were identified in more than half of all FN episodes, and microbiological pathogens were isolated in 54.9% of cases. Gram-positive organisms predominated, followed by Gram-negative bacteria. Poor or delayed early response to empirical antibiotic therapy was frequently associated with severe infection and bacteremia. Conclusion: These findings indicate that FN remains a significant clinical challenge in pediatric hematological malignancies. Secondary FN episodes, prolonged neutropenia, thrombocytopenia, elevated bilirubin levels, and inadequate early treatment response were associated with more severe clinical courses. Early recognition of high-risk features and adaptation of empirical therapy based on local microbiological patterns may improve clinical outcomes.

Keywords

• Febrile neutropenia
• hematologic neoplasms
• infectious agents
• pediatric
• prognosis

Supporting Institution

There is no financial support.

Project Number

KA12-117

Ethical Statement

This retrospective study was approved by the Baskent University Non-Interventional Clinical Research Ethics Committee (Date: 2012/5/22, decision no: KA 12/117) and was conducted in accordance with the Declaration of Helsinki.

Thanks

I sincerely thank my thesis advisor, Prof. Dr. İsmail Zafer Ecevit, for his guidance and support, and Prof. Dr. Esra Baskın for her inspiring mentorship and ethical example. I am grateful to Prof. Dr. Namık Özbek for his encouragement, and to Dr. Ayşe Canan Yazıcı and M. Agah Tekindal for their help with the statistical analysis. I also thank all the faculty who generously shared their knowledge and experience throughout my training.

Nötropenik Ateş Tanılı Çocuk Hastalarda Risk Faktörleri, Etken Mikroorganizmalar ve Prognozun Değerlendirilmesi

Abstract

Amaç: Febril nötropeni (FN), hematolojik maligniteli çocuklarda önemli bir morbidite ve mortalite nedenidir ve acil ampirik antimikrobiyal tedavi gerektirir. Bu çalışma, pediatrik hastalarda FN epizotlarının klinik özelliklerini, laboratuvar bulgularını, mikrobiyolojik profillerini, tedavi yanıtlarını ve sonuçlarını değerlendirmeyi amaçlamıştır. Materyal ve Metot: Başkent Üniversitesi Hastanesi’nde 0–18 yaş aralığında izlenen 88 çocuk hastada gözlenen toplam 397 FN epizodu retrospektif olarak incelendi. FN epizodlarına ait klinik bulgular, laboratuvar parametreleri ve mikrobiyolojik sonuçlar analiz edilerek etken mikroorganizmalar ve olumsuz klinik sonuçların öngördürücüleri araştırıldı. Bulgular: Sekonder FN epizodlarının, primer epizodlara kıyasla yedi gün veya daha uzun sürme olasılığının daha yüksek olduğu ve ampirik antibiyotik tedavisinde değişiklik gereksiniminin daha sık görüldüğü saptandı. Trombositopeni, düşük mutlak monosit sayısı ve total ile direkt bilirubin düzeylerinde artış sekonder epizodlarda daha sık izlendi. FN epizodlarının yarıdan fazlasında klinik olarak belgelenmiş enfeksiyon saptanırken, olguların %54,9’unda mikrobiyolojik etken izole edildi. Gram-pozitif mikroorganizmalar en sık izole edilen etkenler olup, bunu Gram-negatif bakteriler izledi. Ampirik antibiyotik tedavisine erken dönemde yetersiz veya gecikmiş yanıt, sıklıkla ciddi enfeksiyon ve bakteriyemi ile ilişkili bulundu. Sonuç: Bu bulgular, hematolojik malignitesi olan çocuk hastalarda FN’nin önemli bir klinik sorun olmaya devam ettiğini göstermektedir. Sekonder FN epizodları, uzamış nötropeni, trombositopeni, yüksek bilirubin düzeyleri ve ampirik antibiyotik tedavisine yetersiz erken yanıt, daha ağır klinik seyir ile ilişkili bulunmuştur. Yüksek riskli hastaların erken dönemde tanınması ve yerel mikrobiyolojik dağılım ile direnç paternlerine göre ampirik tedavinin uyarlanması, klinik sonuçların iyileştirilmesine katkı sağlayabilir.

Keywords

• Febril nötropeni
• hematolojik malignite
• infeksiyoz ajanlar
• pediatrik
• prognoz

Supporting Institution

Herhangi bir finansal destek bulunmamaktadır.

Project Number

KA12-117

Ethical Statement

Bu retrospektif çalışma, Baskent Üniversitesi Girişimsiz Klinik Araştırma Etik Komitesi tarafından onaylanmış (Tarih: 5.2012.22, karar no: KA 12/117) ve Helsinki Bildirgesi'ne uygun olarak yürütülmüştür.

Thanks

Tez danışmanım Prof. Dr. İsmail Zafer Ecevit’e rehberliği ve desteği için, Prof. Dr. Esra Baskın’a ilham verici mentörlüğü ve etik duruşu için içtenlikle teşekkür ederim. Destek ve teşvikleri için Prof. Dr. Namık Özbek’e, istatistiksel analizlerdeki katkıları için Dr. Ayşe Canan Yazıcı ve M. Agah Tekindal’e teşekkürlerimi sunarım. Ayrıca, eğitim sürecim boyunca bilgi ve deneyimlerini cömertçe paylaşan tüm öğretim üyelerine teşekkür ederim

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