Clinical Outcome, Microbiologic Etiology and Pulmonary Tomographic Findings in Children With Cancer and Episodes of Persistent High-risk Febrile Neutropenia.
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BACKGROUND: Febrile neutropenia (FN) is one of the most frequent complications of antineoplastic treatment in patients with cancer. Invasive bacterial infections and invasive fungal infections are a major cause of morbidity and mortality in this population, along with respiratory viral infections, which are increasingly recognized in children with FN episodes. OBJECTIVES: This study aimed to compare the clinical outcome of children with persistent high-risk FN (HRFN) that have an abnormal chest computed tomography (CT) versus those with normal chest CT or in which chest CT was not indicated, and to evaluate the microbiologic etiology and pulmonary tomographic findings in this population. METHODS: Patients with persistent HRFN were prospectively enrolled between 2016 and 2021 and classified into 2 groups: children with persistent HRFN that had an abnormal chest CT and children that had a normal chest CT or in which chest CT was not clinically indicated. We compared the clinical outcome of the patients of the 2 groups. Children with abnormal chest CT underwent a microbiologic and molecular study to evaluate the etiology of the pulmonary compromise. After discharge, all children with persistent HRFN that had an abnormal chest CT were evaluated by 2 groups of independent, blind investigators: 1 pediatric infectious disease specialist that classified the etiology of the pulmonary infiltrate as bacterial, fungal, viral or unknown etiology and 2 pediatric radiologists that classified each chest CT, as defined by the Fleischner Society. RESULTS: We enrolled 176 children with persistent HRFN, of which 36 had abnormal chest CT. In 27/36 episodes (75%), the etiology was determined (12 bacterial, 8 viral and 7 fungal). Subjects with an abnormal chest CT had more days of fever, longer length of hospital stay, higher PICU admission, more use of mechanical ventilation, more oxygen requirement, longer periods of antibacterial and antifungal therapy. Chest CT showed no statistically significant differences when findings were compared by etiology of the episodes. CONCLUSIONS: Our results strongly support that abnormal findings on chest CT in children with persistent HRFN should be interpreted as a predictor of poor clinical outcome, as not as a marker of etiology.