title: Causative Pathogens of Febrile Neutropaenia in Children Treated for Acute Lymphoblastic Leukaemia.
abstract: BACKGROUND
  Treatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.
  
  
  METHODS
  Patients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.
  
  
  RESULTS
  There were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.
  
  
  CONCLUSIONS
  Febrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.
authors.affiliation: Paediatric Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
authors.forename: Joyce Cm
authors.initials: JC
authors.lastname: Lam
authors.forename: Jie Yang
authors.initials: JY
authors.lastname: Chai
authors.forename: Yi Ling
authors.initials: YL
authors.lastname: Wong
authors.forename: Natalie Wh
authors.initials: NW
authors.lastname: Tan
authors.forename: Christina Tt
authors.initials: CT
authors.lastname: Ha
authors.forename: Mei Yoke
authors.initials: MY
authors.lastname: Chan
authors.forename: Ah Moy
authors.initials: AM
authors.lastname: Tan
mesh_terms: D002177:Candidiasis / Q000453:epidemiology; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology; D009181:Mycoses / Q000453:epidemiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011552:Pseudomonas Infections / Q000453:epidemiology; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology; D014777:Virus Diseases / Q000453:epidemiology*