Infections during Non‐Neutropenic Episodes in Pediatric Cancer Patients—Results from a Prospective Study in Two Major Large European Cancer Centers

Abstract

Whereas the clinical approach in pediatric cancer patients with febrile neutropenia is well established, data on non‐neutropenic infectious episodes are limited. We therefore prospectively collected over a period of 4 years of data on all infectious complications in children treated for acute lymphoblastic or myeloid leukemia (ALL or AML) and non‐Hodgkin lymphoma (NHL) at two major pediatric cancer centers. Infections were categorized as fever of unknown origin (FUO), and mi-crobiologically or clinically documented infections. A total of 210 patients (median age 6 years; 142 ALL, 23 AML, 38 NHL, 7 leukemia relapse) experienced a total of 776 infectious episodes (571 during neutropenia, 205 without neutropenia). The distribution of FUO, microbiologically and clinically documented infections, did not significantly differ between neutropenic and non‐neutropenic episodes. In contrast to neutropenic patients, corticosteroids did not have an impact on the infectious risk in non‐neutropenic children. All but one bloodstream infection in non‐neutropenic patients were due to Gram‐positive pathogens. Three patients died in the context of non‐neutropenic infectious episodes (mortality 1.4%). Our results well help to inform clinical practice guidelines in pediatric non‐neutropenic cancer patients presenting with fever, in their attempt to safely restrict broad‐spectrum antibiotics and improve the quality of life by decreasing hospitalization.