Study on antibiotic prescription patterns, microbiological spectrum and clinical outcomes of febrile neutropenia in pediatric oncology patients.

BACKGROUND

Data of various infections in febrile neutropenia (FN) in pediatric oncology patients in era of high burden of antimicrobial resistance (AMR) is lacking.

METHODS

This was a prospective observational study conducted in a pediatric oncology unit of a tertiary level dedicated oncology center from March 2025 to September 2025. We recruited patients with FN and studied antibiotic prescription patterns, microbiological data with relation to patient outcomes.

RESULTS

Among the 122 FN episodes assessed, FN without microbiologically documented infection (MDI) or clinically documented infection (CDI) was observed in 66 cases (54.1%). FN with a CDI occurred in 35 cases (28.7%), while FN with a MDI was identified in 21 cases (17.2%). In our study 67% of FN episodes responded while on 1st line antibiotics and antibiotic escalation was required in 33% of episodes, out of which 1/3rd was targeted (i.e. based on culture) and in only 28 out of 122 (23%) episode was antibiotics escalated due to clinical reasons (hemodynamic compromise, new localization or persistent fever for >4 days). In 8 episodes (6.5%) hemodynamic instability was seen requiring intensive care unit (ICU) care and death occurred in 3 episodes.

CONCLUSION

Prevalence of microbiology proven infection is low in FN in pediatric oncology settings and also that majority of the patients can be managed with 1st line antibiotics with only few requiring escalation to carbapenem and even fewer requiring escalation to last resort antibiotics.