2397. Febrile Neutropenia Syndromes in Children: Should Management Differ for Primary, Persistent, Recurrent or Engraftment Fever?
Session: Poster Abstract Session: Transplantation - Prophylaxis and Prediction
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • FN Pediatric ID week monday print .pdf (1.3 MB)
  • Background:

    Febrile neutropenia (FN) is a common in children receiving chemotherapy and can be life-threatening. Four febrile neutropenia syndromes: primary, prolonged, recurrent and engraftment fever have been described. Recognition of these syndromes may inform the clinical approach to the diagnosis and treatment of FN in pediatric cancer patients.

    Methods:

    Retrospective chart review was performed in all pediatric cancer patients with FN from July 2009 to December 2016, Each episode of FN was categorized as 1) Primary, responsive to empiric antibiotic therapy, 2) Prolonged, failing to defervesce after at least 5 days of broad spectrum antibacterial therapy 3) Recurrent, a new episode of fever > 72 hours from resolution of the initial fever episode when the patient remains neutropenic and on antibiotics, or 4) Engraftment fever, a new onset fever or clinical worsening in temporal relationship to neutrophil recovery. Patient demographics and clinical outcomes were compared by syndrome using chi-square and student’s t-test where appropriate to evaluate for differences in presentation, etiologies of fever and clinical outcomes. 

    Results:

    562 pediatric FN episodes (FNEs) occurred in 169 patients. 63% of FNEs occurred in patients with hematologic malignancy, 24.4% occurred s/p stem cell transplant (SCT). FNEs were categorized as primary (67.3%), prolonged (18.5%), recurrent (9.6%), and engraftment fever (4.6%). Episodes categorized as prolonged or recurrent occurred most often in patients with hematologic malignancy, 63% and 87%. Bacteremia was documented in 22% of FEs and by syndrome 28.2%, 34%, 26%, and 7.7%, respectively, Fungal infection was documented in 9.4% of FNEs and by syndrome, 2.4%, 19 %, 30%, 30.8%, respectively. When recurrent and prolonged fever episodes were compared, proven fungal infections occurred more often (1% vs 11%) (P value=0.015) and mortality was increased 13% vs 3.8% (P value 0.07) in patients with recurrent fever

    Conclusion:

    Pediatric patients with recurrent febrile neutropenia are more likely to have invasive fungal infections and increased mortality. Prospective studies are needed to inform whether approaches in medical management should differ depending on the presenting febrile neutropenia syndrome.

    Muayad Alali, MD1, Michael Z David, MD PhD2, Allison Bartlett, MD3, Lindsay Petty, MD4, Anoop Mayampurath, PhD4 and Jennifer Pisano, MD4, (1)Pediatric Infectious Disease, University of Chicago/ Comer Children Hospital, chicago, IL, (2)Section of Infectious Diseases and Global Health, Dept of Medicine, University of Chicago Medicine, Chicago, IL, (3)Department of Pediatrics, Section Infectious Disease, University of Chicago / Comer Children Hospital, Chicago, IL, (4)University of Chicago, chicago, IL

    Disclosures:

    M. Alali, None

    M. Z. David, None

    A. Bartlett, None

    L. Petty, None

    A. Mayampurath, None

    J. Pisano, None

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