Profile of febrile neutropenia in childhood cancer patients and the clinical utility of procalcitonin and C-reactive protein in identifying severe infections

Objectives: Febrile neutropenia (FN) is a medical emergency requiring prompt diagnosis of underlying infection and early administration of antibiotics. Updates about the spectrum and resistance patterns of pathogens isolated are essential for the successful management of FN. Materials and Methods: The purpose of this study was to describe the clinical profile, outcome, infective pattern and the clinical utility of procalcitonin (PCT) and C-reactive protein (CRP) in febrile neutropenic children, admitted to our center between 2017 and 2019. Children aged <18 years with confirmed malignancy and FN were enrolled in the study. Results: The study population was 54 patients. A total of 90 episodes of FN were noted. Hematologic malignancies accounted for 74% of the cases. Only 15 (16.6%) of the study population had clinical foci of infection. Overall culture positivity was 20 %. Among the children with central venous catheter, 21.8% had culture positivity. The most common bacterial isolates were Gram-negative bacilli, with Acinetobacter being the most common pathogen. The overall mortality rate was 5.5%. Among 18 culture positive cases, CRP was positive in 10 (55.5 %) cases and PCT was positive in 12 (66.6 %) cases. Conclusion: Gram-negative organisms are the major infective agents in developing countries. Central venous catheter remains the foci of infection in these patients. Raised CRP and PCT are predictors of complications during FN.