Epidemiological profile of febrile neutropenia in children at three referral hospitals in Rwanda: A 5-year retrospective study

Abstract

INTRODUCTION: Febrile neutropenia (FN) is an oncological emergency and requires prompt intervention. Recommended management of febrile neutropenia is based on local epidemiology of microorganisms. Rwanda lacks data on local epidemiology for febrile neutropenia. This study aims to highlight the epidemiology of bacteremia causing febrile neutropenia in pediatric populations in Rwanda. METHODS: A retrospective cross-sectional study was conducted over a period of 5 years at three referral hospitals in Rwanda. This study included patients with febrile neutropenia aged less than 15 years. A structured questionnaire was used for data collection, and Stata version 13 was used for analysis. RESULTS: This is the 1st study describing the epidemiology of microorganisms in neutropenic cancer patients in Rwanda. A total of 138 children were included in this study; 92 patients (67%) had hemato-oncology diseases, with acute lymphoblastic leukemia (ALL) represented at 50%, while 46 patients (33%) were non-cancer patients. Prevalence of FN in hemato-oncology was 36%. The rate of bacteremia was 37.6% (52/138). Gram-negative pathogens predominated at 65.4% of all isolates, with Escherichia coli being more common. Concerning antibiotic susceptibility, Gram negatives were largely resistant to 3rd generation cephalosporins, but most of them showed sensitivity to carbapenems. Unfortunately, 67% of S. aureus was mainly MRSA. The 30-day all-cause mortality rate in cancer patients with FN was 19%. CONCLUSION: This study showed that E. coli was the most common organism causing bacteremia in febrile neutropenic pediatric patients, with high resistance to 3rd generation cephalosporins and gentamicin. The use of carbapenems as empiric treatment of febrile neutropenia is highly recommended.