Febrile Neutropenic Sepsis in Paediatric Oncology Patients

Background: Neutropenia is a common side effect of chemotherapy caused by bone marrow suppression in oncology patients. These factors disrupt the normal immune response and predispose to infection caused by Gram‐negative and positive bacteria as well as fungi. The morbidity and mortality associated with these infections led to the routine use of antibiotic treatment which is given upon suspicion of infection even before the causative pathogens are identified. It is recommended that all paediatric oncology patients who present with temperature of 38^oC or more should receive antibiotics within one hour of their arrival without waiting for their blood results.

Objective: We evaluated our practice to ascertain whether we are meeting this gold standard treatment guideline.

Methods: Paper and electronic records of all paediatric oncology patients admitted over a period of 4 years (2014 to 2018) with febrile illness were analysed. Patients were identified using paediatric oncology database maintained locally.

Results: Out of 24 admissions (9 patients), 8 were not neutropenic. Mean neutrophil count was 0.4 x 10*9/L. Mean temp on admission was 38.3^oC. All patients received Tazocin as first line antibiotic. Patients received antibiotics within one hour of their arrival during 53% of admissions only. Main reasons for delay were issues with central line, concurrent emergencies and lack of immediate availability of drug from pharmacy. Mean length of stay was 4 days.

Conclusion: Antibiotic administration within 1 hour during febrile neutropenic oncology admissions is far from satisfactory. An electronic blood set and antibiotic prescription system is being implemented for all febrile neutropenic admissions which is likely to over the shortcoming.