title: Evaluation of predictors of adverse outcome in febrile neutropenic episodes in pediatric oncology patients.
abstract: OBJECTIVE
  To identify predictors associated with adverse outcome in febrile neutropenic episodes among pediatric oncology patients between 1 and 18 y age, to ascertain the prevalence of invasive bacterial or fungal infection/mortality, to determine the common organisms causing invasive bacterial infection in children with febrile neutropenia and to evaluate their current antimicrobial sensitivity pattern.
  
  
  METHODS
  It was an observational descriptive study conducted between February 2009 through July 2010. Febrile neutropenic episodes satisfying the inclusion criteria were enrolled. Relevant history was taken followed by a detailed clinical examination and laboratory examination. Logistic Regression analysis was used to identify significant predictors of adverse outcome in febrile neutropenic episodes.
  
  
  RESULTS
  Out of the 155 febrile neutropenic episodes studied, adverse outcome occurred in 53(34 %) of the episodes. History of three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radiograph abnormality at presentation were found to be significantly associated with adverse outcome on multivariate logistic regression analysis. Documented invasive bacterial and fungal infection was seen in 27.8 % and 14.2 % episodes. Mortality occurred in 8 (5 %) of episodes. Gram negative bacterial infections were more common. Most common bacteria isolated was Escherichia coli and the commonest gram positive organism isolated was Staphylococcus aureus (MSSA).
  
  
  CONCLUSIONS
  On multivariate analysis, the variables found to be significantly associated with adverse outcome in febrile neutropenic episodes were three or more previous episodes of febrile neutropenia, child being already on oral antibiotics and Chest Radioraph abnormality at presentation.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Bothra
authors.forename: Rachna
authors.initials: R
authors.lastname: Seth
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.forename: S N
authors.initials: SN
authors.lastname: Dwivedi
authors.forename: Shinjini
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: Immaculata
authors.initials: I
authors.lastname: Xess
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000382:microbiology*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications*; D017063:Outcome Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents