Febrile neutropenia in children with acute lymphoblastic leukemia (ALL)

Abstract

Introduction: Febrile neutropenia is the first manifestation of a life threatening infection in patients undergoing chemotherapy.

Objectives: an analysis of the profile of febrile neutropenic episodes in patients under 15 years treated for ALL in Valdivia.

Patients and methods: We reviewed 150 episodes in children enrolled in the ALL childrens protocol PINDA 96 MINSAL at the Regional Clinical Hospital Valdivia between 1996 and 1999.

Results: 71.4% of episodes were during severe neutropenia (RAN <500/mm3). The source of the infection was established in 72.6% of cases, the most frequent focus was respiratory 53.4% (80/150). The causative organism was identified in 29.3%, with a predominance of gram + followed by gram- and fungi. 11.4% had positive blood cultures, 46% being gram -- bacilli, 34.6% gram + cocci, 11.8% Candida and 3.8% gram + bacilli. Treatment with iv cloxacillin 100 mg/kg/day and iv amikacin 15 mg/kg/day was successful in 66%, increasing to a 94% success rate with the addition of iv ceftriaxone 100 mg/kg/day.

Conclusions: We obtained an appropriate identification of the infective focus in febrile neutropenic episodes in patients with ALL, and an adequate control with combined antibiotic therapy.