Invasive fungal infection in children with persistent febrile neutropenia.
OBJECTIVE
Children with persistent febrile neutropenia (fever > 96 hours) refractory to antibacterial therapy carry a high risk of invasive fungal infection (IFI). However, epidemiologic data in such patient populations is lacking in Taiwan.


METHODS
A retrospective study was conducted to identify risk factors and outcome of IFI in children with persistent febrile neutropenia (> 96 hours) hospitalized at National Taiwan University Hospital from January 1, 1999 through December 31, 1999. They were categorized into proven, probable, possible, or no IFI according to host, microbiologic and clinical criteria.


RESULTS
A total of 29 episodes (35.4%) of IFI occurred in 82 episodes of persistent febrile neutropenia and included 1 proven, 12 probable and 16 possible cases. Pneumonia was most common (69.0%), followed by disseminated infection (17.2%), paranasal sinusitis (6.9%), and hepatosplenic abscess (6.9%). Multivariate analysis revealed 4 risk factors independently associated with IFI: prolonged neutropenia (> 30 days; odds ratio [OR], 10.4; 95% confidence interval [CI], 1.8-60.5), prolonged steroid therapy (OR 2.0, 95% CI 1.0-10.8), allogeneic bone marrow transplantation (OR 5.3, 95% CI 1.0-28.0), and relapsed malignancy (OR 3.5, 95% CI 1.1-11.1). Patients with IFI carried higher in-hospital mortality than those without (51.7% vs 3.8%, p < 0.001). Among those with IFI, delayed antifungal therapy (persistent fever > 7 days) was associated with higher mortality rate than earlier treatment (73.3% vs 28.6%, p = 0.024) and was an independent adverse prognostic factor.


CONCLUSIONS
IFI was common in patients with persistent febrile neutropenia and delayed antifungal therapy was an independent adverse prognostic factor.
Lai
Hsin-Pao
HP
Department of Pediatrics, God's Help Hospital, Taipei, Taiwan.
Chen
Yee-Chun
YC
Chang
Luan-Yin
LY
Lu
Chun-Yi
CY
Lee
Chin-Yun
CY
Lin
Kai-Hsin
KH
Huang
Li-Min
LM
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome