Background: Febrile neutropenia (FN) is one of the most serious hematologic complications seen in acute lymphoblastic leukemic patients receiving chemotherapy. So,immediate administration of empiric, broad-spectrum, I.V antibiotics is required. However, not all these patients have the same risk for infectious complications during FN. Objectives: The aim of this work was to study risk of bacteremia and fungemia and also to identify the type of bacterial and fungal isolates in these children. Patients and methods: 30 acute lymphoblastic leukemic patients from Hematology and Oncology Unit, Benha Specialized Children's Hospital were assessed and all attacks of FN occurred in these children during the period between August 2007 and April 2010 were documented and analysed. Results: Total number of attacks of FN was 98, the prevalence of infection during these attacks was 53.1%, bacterial infection only was 30.6%,fungal infection only was 16.3% and combined bacterial and fungal infections were 6.1%. Gram +ve organisms constituted 63.9% while gram –ve organisms constituted 36.1% of febrile neutropenic attacks with bacterial infection. Among gram +ve organisms, staph aureus was the most common (91.3%), then b-hemolytic streptococci (8.7%). Among gram –ve organisms, E-coli was the most common (46.1%), then klebsiella, pseudomonas and acinetobacter (30.8%,15.4% and7.7% respectively). Aspergillus fumigatus constituted 45.5%, aspergillus niger 22.7%, candida albicans 27.3% and candida tropicalis constituted 4.5% of febrile neutropenic attacks with fungal infection. Higher degrees of temperature, longer duration of neutropenia, presence of hypotension, chest manifestations and chest x-ray abnormalities were highly significant in febrile neutropenic attacks with infection versus attacks without infection. Also, lower values of absolute neutrophilic count (ANC), absolute monocytic count (AMC), absolute phagocytic count (APC) and platelets and higher values of C-reactive protein (CRP) were highly significant in attacks with infection versus attacks without infection. Conclusion: Not all acute lymphoblastic leukemic patients who develop FN have the same risk for infectious complications.So,examination of certain clinical, radiological and laboratory parameters would help in identification of patients at low-risk for infectious complications who could be safely treated in an outpatient setting with minimal antibiotic treatment. |
