Management and outcome of febrile neutropenia in admitted presumed immunocompetent patients with suspected viral illness

Estelle M Morin; Catherine Corriveau-Bourque; Jessica L Foulds

doi:10.1093/pch/pxac053

Management and outcome of febrile neutropenia in admitted presumed immunocompetent patients with suspected viral illness

Paediatr Child Health. 2022 Aug 26;27(7):408-413. doi: 10.1093/pch/pxac053. eCollection 2022 Dec.

Authors

Estelle M Morin¹, Catherine Corriveau-Bourque², Jessica L Foulds³

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
² Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
³ Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Objectives: Febrile neutropenia (FN) creates concern in paediatrics due to the risk of serious bacterial infections (SBI). Protocols with empiric antibiotics designed for hematology and oncology are often applied in healthy children with FN despite lower rates of SBI in this population. This study quantifies rates of infections in presumed immunocompetent children hospitalized with suspected viral illnesses and FN.

Methods: This was a retrospective chart review of healthy children admitted to the Stollery Children's Hospital between 2007 and 2017 with fever, absolute neutrophil counts < 0.5 × 109/L, and viral symptoms. Primary outcomes were the incidence of SBI and bacterial pneumonia.

Results: Of 383 encounters reviewed, 96 admissions for 82 patients met inclusion criteria. Eighty-eight encounters (91.7%) were managed with empiric antibiotics. Viruses were identified in 42% of encounters. Three blood cultures were positive for coagulase-negative Staphylococcus and one for Coryneforms, all considered contaminants. There were three urinary tract infections and two pneumonias. Eighty-three per cent of patients had normalization of neutrophil counts, with a median neutropenia duration of 3.2 months. Follow-up diagnoses included chronic benign neutropenia of childhood (N = 17) and three rheumatologic/autoimmune conditions (N = 3).

Conclusion: Our results support previous findings of low rates of invasive bacterial infections in healthy children with FN. With an SBI rate of 3.1% and few patients found to have any pathologic etiology for their neutropenia, prospective studies would be valuable to evaluate the need for a practice change regarding antibiotic use in low-risk patients with suspected viral-induced neutropenia.

Keywords: Antibiotics; Benign neutropenia; Febrile neutropenia; Hematology; Infectious diseases; Serious bacterial infections.