Frontiers in pediatrics · 2026
Febrile neutropenia in children and adolescents with acute myeloid leukemia during induction therapy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Rebah Manel, Azza Emna, Ben Jemia Emna, Ben Abdennebi Yosr, Ben Othmen Eya, Hsasna Roua, Bahri Maroua, Aissaoui Lamia
Аннотация
BACKGROUND: Febrile neutropenia (FN) is a serious and potentially life-threatening complication in children with acute myeloid leukemia (AML), particularly during induction chemotherapy. However, data from low- and middle-income countries remain limited.
METHODS: We conducted a retrospective study including children and adolescents with newly diagnosed AML who experienced at least one FN episode during induction therapy at Aziza Othmana Hospital, Tunis, Tunisia.
RESULTS: Among 63 patients with AML, 55 (87.3%) experienced 82 FN episodes. No patient received antibacterial or antifungal prophylaxis. Clinically documented infections (CDI) accounted for 53.6% of episodes, fever of unknown origin for 25.7%, and microbiologically documented infections (MDI) for 20.7%. The gastrointestinal tract was the most frequent site of infection (50%), followed by the respiratory tract (31.8%). Blood cultures yielded predominantly Gram-negative bacilli and Gram-positive cocci in similar proportions. Multidrug-resistant Gram-negative bacteria were identified in five episodes. Clinical outcomes were favorable in 77 episodes (94%), with a median time to defervescence of four days. Five patients died, resulting in a FN-related mortality rate of 9%. Intensive care unit (ICU) admission and presence of sepsis/septic shock were associated with mortality in univariate analysis.
CONCLUSION: FN remains a major cause of morbidity and mortality during AML induction therapy. Early recognition, prompt antimicrobial treatment, and improved access to microbiological diagnostics may improve outcomes in resource-limited settings.
METHODS: We conducted a retrospective study including children and adolescents with newly diagnosed AML who experienced at least one FN episode during induction therapy at Aziza Othmana Hospital, Tunis, Tunisia.
RESULTS: Among 63 patients with AML, 55 (87.3%) experienced 82 FN episodes. No patient received antibacterial or antifungal prophylaxis. Clinically documented infections (CDI) accounted for 53.6% of episodes, fever of unknown origin for 25.7%, and microbiologically documented infections (MDI) for 20.7%. The gastrointestinal tract was the most frequent site of infection (50%), followed by the respiratory tract (31.8%). Blood cultures yielded predominantly Gram-negative bacilli and Gram-positive cocci in similar proportions. Multidrug-resistant Gram-negative bacteria were identified in five episodes. Clinical outcomes were favorable in 77 episodes (94%), with a median time to defervescence of four days. Five patients died, resulting in a FN-related mortality rate of 9%. Intensive care unit (ICU) admission and presence of sepsis/septic shock were associated with mortality in univariate analysis.
CONCLUSION: FN remains a major cause of morbidity and mortality during AML induction therapy. Early recognition, prompt antimicrobial treatment, and improved access to microbiological diagnostics may improve outcomes in resource-limited settings.