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Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia

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Abstract

Febrile neutropenia (FN) is the most common haematological toxicity associated with cytotoxic chemotherapy. Individual studies are available, but national estimates on FN are required. To describe chemotherapy-induced neutropenia, its associated infection-causing organisms, and the antimicrobials prescribed, a prospective cum retrospective study was conducted for a period of 9 months, which included 50 paediatric cancer patients less than 18 years. Patients having an absolute neutrophil count (ANC) less than 1500/mm3, having body temperature of above 38.5 °C, and receiving anti-infectives as prophylaxis were included. Patient demographic details, presenting complaints, absolute neutrophil count, and laboratory findings were noted in a patient proforma. Out of the overall 584 episodes of CIN, 188 episodes (32.2%) were of febrile neutropenia. Majority of patients were boys (70%), aged between 1 and 6 years (66%), and diagnosed with acute lymphoblastic leukemia (64%). The mean ANC was 765.6 ± 235.7 × 109/l. From a total of 188 episodes of FN, in 179 episodes, patients had ANC < 500 mm3, whereas in 9 episodes, patients had ANC < 100 mm3. The predominant site of infection in these patients was bloodstream (27%), followed by urine (6%) and stool (1%). From the 51 episodes of blood culture done, the highest reported was of Staphylococcus species (49.01%). Anti-infective combinations of piperacillin/vancomycin (56%) and piperacillin/amikacin (42%) were given. Patients with positive fungal growth received Inj. amphotericin (18%) as therapy. Majority of the children undergoing chemotherapy, diagnosed with ALL, had FN. Low ANC led them susceptible to various bacterial and fungal infections. Introduction to antimicrobials and antifungals have all contributed to decreasing chemotherapy-related infections.

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Acknowledgments

We would like to thank all the staff including residents, doctors, and nurses of Bharati Hospital and Research Centre, Bharati Vidyapeeth Deemed University, Pune, for helping us in the completion of the study.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India

    Nissi Lisa Abraham, Acsah Joy George, Manjusha Sajith, Vibha Bafna & Sandeep Bartakke

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  1. Nissi Lisa Abraham
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  2. Acsah Joy George
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All authors discussed the results and contributed to the final manuscript.

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Correspondence to Nissi Lisa Abraham.

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The authors declare that they have no conflict of interest.

Ethical Statement

The study complied with all ethical standards.

Informed Consent

Patient caretaker informed consent was taken in an informed consent form for children below 12 years of age, which was agreed to be duly signed by patient’s caretaker. Informed patient assent was taken and duly signed by children above 12 years before initiating the study.

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Abraham, N.L., George, A.J., Sajith, M. et al. Assessment of Antimicrobial Prescription Pattern among Paediatric Cancer Patients with Febrile Neutropenia. SN Compr. Clin. Med. 1, 378–383 (2019). https://doi.org/10.1007/s42399-019-00055-8

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