Infection profile and risk factors for adverse outcomes in children with febrile neutropenia: a single-center study from Northwestern India.
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Febrile neutropenia (FN) is a critical medical emergency in pediatric oncology. Our study addressed the lack of research on Indian children with acute leukemia, aiming to improve FN management using region-specific data. This cross-sectional study was conducted in Northwestern India from January 2022 to October 2023. FN episodes that met the inclusion criteria were enrolled in the study. The microbiological spectrum, antibiotic susceptibility patterns, risk factors, prognostic markers, and clinical outcomes were investigated. Logistic regression analysis was used to identify significant predictors of adverse outcomes. In total,207 FN episodes were documented in 90 children. Microbiological confirmation was observed in 17.9% (n = 37) of the FN episodes, and bloodstream infection was present in 10.6% (n = 22). Gram-negative bacteria accounted for 85.2% (n = 23) of the bacterial isolates, the most common being Pseudomonas aeruginosa (n = 7). Invasive fungal disease was observed in 3.4% (n = 7) of episodes. Intensive care was required for management in 14.5% (n = 30) episodes, the commonest indication being septic shock. Mortality during FN episodes was found to be 6.3% (n = 13). Profound neutropenia at presentation was a predictor of prolonged hospital stay. CRP was a predictor of mortality and the need for intensive care. Procalcitonin was a predictor of all adverse outcomes explored in the study-bloodstream infection, mortality, need for intensive care, and prolonged hospital stay. According to the available data, gram-negative organisms dominate bloodstream infections in this part of the world. Procalcitonin is a valuable predictor of adverse outcomes in FN, guiding early antibiotic escalation to improve outcomes.