Dokuz Eylül University Faculty of Medicine, Division of Pediatric Infectious Diseases, İzmir, Türkiye
Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, İzmir, Türkiye
Turk J Haematol. 2023 Aug 31;40(3):143-153. doi: 10.4274/tjh.galenos.2023.2023.0185. Epub 2023 Aug 1.
Febrile neutropenia (FN) is an important complication that causes high rates of morbidity and mortality in patients with malignancies. We aimed to investigate the etiology, epidemiological distribution and its change over the years, clinical courses, and outcomes of FN in children with acute leukemia.
We retrospectively analyzed the demographic data, clinical characteristics, laboratory results, severe complications, and mortality rates of pediatric patients with FN between January 2010 and December 2020.
In 153 patients, a total of 450 FN episodes (FNEs) occurred. Eighty-four (54.9%) of these patients were male, the median age of the patients was 6.5 (range: 3-12.2) years, and 127 patients (83%) were diagnosed with acute lymphoblastic leukemia. Fever with a focus was found in approximately half of the patients, and an etiology was identified for 38.7% of the patients. The most common fever focus was bloodstream infection (n=74, 16.5%). Etiologically, a bacterial infection was identified in 22.7% (n=102), a viral infection in 13.3% (n=60), and a fungal infection in 5.8% (n=26) of the episodes. Twenty-six (23.2%) of a total of 112 bacteria were multidrug resistant (MDR) The rate of severe complications was 7.8% (n=35) and the mortality rate was 2% (n=9). In logistic regression analysis, refractory/relapsed malignancies and high C-reactive protein (CRP) at first admission were found to be the most important independent risk factors for mortality. Prolonged neutropenia after chemotherapy, diagnosis of acute myeloid leukemia, identification of fever focus or etiological agents, invasive fungal infections, polymicrobial infections, and need for intravenous immunoglobulin treatment increased the frequency of severe complications.
We found that there was no significant change in the epidemiological distribution or frequency of resistant bacteria in our center in the last 10 years compared to previous years. Prolonged duration of fever, relapsed/refractory malignancies, presence of fever focus, and high CRP level were significant risk factors for poor clinical course and outcome.
发热性中性粒细胞减少症（FN）是一种重要的并发症，可导致恶性肿瘤患者的发病率和死亡率居高不下。我们旨在研究儿童急性白血病患者 FN 的病因、流行病学分布及其多年来的变化、临床过程和结局。
我们回顾性分析了 2010 年 1 月至 2020 年 12 月期间患有 FN 的儿科患者的人口统计学数据、临床特征、实验室结果、严重并发症和死亡率。
在 153 名患者中，共有 450 次 FN 发作（FNEs）。其中 84 名（54.9%）为男性，患者中位年龄为 6.5（范围：3-12.2）岁，127 名（83%）被诊断为急性淋巴细胞白血病。约一半的患者出现发热伴焦点，其中 38.7%的患者确定了病因。最常见的发热焦点是血流感染（n=74，16.5%）。病因学上，22.7%（n=102）的病例为细菌感染，13.3%（n=60）为病毒感染，5.8%（n=26）为真菌感染。总共 112 种细菌中有 26 种（23.2%）为多药耐药（MDR）。严重并发症的发生率为 7.8%（n=35），死亡率为 2%（n=9）。在逻辑回归分析中，难治/复发恶性肿瘤和初次入院时高 C 反应蛋白（CRP）被发现是死亡的最重要独立危险因素。化疗后中性粒细胞减少持续时间延长、急性髓系白血病诊断、发热焦点或病因学标志物的确定、侵袭性真菌感染、多微生物感染和需要静脉注射免疫球蛋白治疗都会增加严重并发症的发生频率。
我们发现，与前几年相比，在过去 10 年中，我们中心的流行病学分布或耐药菌的频率没有明显变化。发热持续时间延长、难治/复发恶性肿瘤、发热焦点存在和高 CRP 水平是临床病程和结局不佳的显著危险因素。
