title: Episodes of fever and neutropenia in children with cancer in a tertiary care medical center in Turkey.
abstract: The aim of this study was to determine the clinical features and microbiological spectrum during episodes of fever and neutropenia (FEN) in children with cancer. Demographics, clinical information, treatment approaches, and outcomes of the patients admitted to Akdeniz University Department of Pediatric Hematology and Oncology from October 1996 to June 2004 were evaluated retrospectively. Of the total 621 episodes, 345 (55.5%) were microbiologically documented (MDI) (36.4%) or clinically suspected (CSI) (19.2%) infections. A total of 425 infections were diagnosed in 345 episodes, in which lower respiratory tract infections were the most common (32.7%). Among the microbiologically documented infections, Staphylococci (both coagulase-negative and coagulase-positive) (38.7%) and Escherichia coli (12.9%) were the most frequently isolated gram-positive and gram-negative organisms, respectively. Monocytopenia less than 100/microL (p = 0.01), duration of neutropenia (p = .01) and fever (p < .001) were significantly associated with documented infection by univariate analysis. In addition, presence of previous FEN episode (p = .001) and hypotension (p = .029) were also found to be risk factors. However, using the multivariate analyses, only the duration of fever was found to be an independent risk factor for MDI. The rate of mortality was significantly higher among under 1-year-old patients (p = .039). Hypotension and uncontrolled cancer were the significant determinants of poor prognosis. These results may help to consider a more selective management strategy for children with these problems.
authors.affiliation: Akdeniz University Faculty of Medicine, Department of Pediatric Hematology & Oncology, Antalya, Turkey.
authors.forename: Gulsun
authors.initials: G
authors.lastname: Tezcan
authors.forename: Alphan
authors.initials: A
authors.lastname: Kupesiz
authors.forename: Feryal
authors.initials: F
authors.lastname: Ozturk
authors.forename: Dilara
authors.initials: D
authors.lastname: Ogunc
authors.forename: Meral
authors.initials: M
authors.lastname: Gultekin
authors.forename: Akif
authors.initials: A
authors.lastname: Yesilipek
authors.forename: Volkan
authors.initials: V
authors.lastname: Hazar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D002177:Candidiasis / Q000150:complications / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents