Evaluation of the bacterial, viral, fungal and parasitic infection episodes in the children with fever who were treated with chemotherapy between 2015-2018

Background: Survival rates in children with cancer have increased in recent years, but aggressive cancer treatment has resulted in a high risk of infection. Fever is a common condition in cancer patients, and is caused by various infections and non-infectious causes. Infections are the main cause of fever in cancer patients, and should be considered in both neutropenic and non-neutropenic patients. Objective: The aim of this study was to evaluate the frequency of infection, infectious agents and risk factors in pediatric oncology patients who were treated with chemotherapy and presented with fever of 38 ˚C or more. Method: In this retrospective study, the data were obtained by scanning the files of the patients. Ninety-four pediatric cancer patients who presented with fever of 38 ˚C or more, and hospitalized between January 2015 and December 2018 were included into the study. A 212 fever episodes of these patients were evaluated. Age, sex, time elapsed between systemic chemotherapy and infection, length of stay in intensive care unit, infection sites were evaluated. Absolute neutrophil counts were taken into account to relate with febrile episodes. Bacterial and fungal microbiological agents detected by peripheral blood and catheter blood cultures, urine, stool, sputum, throat or swab cultures were documented. Viruses detected by multiplex PCR panel, CMV-DNA PCR, EBV-DNA PCR and stool viral antigen examinations, and the parasites detected in the stool and serological methods were recorded. Antimicrobial treatments were evaluated during hospitalization and discharge. Data were analyzed with SPSS 25.0 package program. Results: Among the patients 43 (45.7%) were female and 51 (54.3%) male. The mean age of the patients was 87,02 months (4-213 months). No infection focus was detected in 103 (48,6%) febrile episodes. Catheter infections were the most common cause of fever. Of the peripheral blood, catheter blood, urine, feces and wound cultures, 46.4% was positive for Gram positive and 53.6% for Gram negative bacteria. Coagulase negative Staphylococci and Escherichia coli are the most common bacteriae. Candida species detected in four patients' urine and catheter blood cultures were the most common fungal agents. Rhinovirus, shown in 12 patients (5.6%), was the most common viral respiratory infection agent. The third generation cephalosporins (preferred in 73.6% of patients) were the most common used antibacterial agents for febrile episodes. There was no statistically significant difference in the distribution of infectious agents and infection diagnoses between the patients with or without neutropenia (p>0,05). Septic shock was more common in neutropenic patients than the non-neutropenic ones (p=0,02). Conclusion: No infection focus was detected in 48.6% of the patients. Catheter infections were the most common cause of fever. Coagulase negative Stafilococcus was the most common bacterial whereas Candida species the most common fungal and Rhinovirus the most common viral agent. There was no difference in the distribution of bacteria, viruses and fungi between patients with and without neutropenia. Key words: Child; cancer; fever; infection; febrile neutropenia.