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 in developed countries which has improved mortality and morbidity associated with FN. Rwanda lacks data on local epidemiology for febrile neutropenia. Objectives: This study intends to highlight the epidemiology of bacteraemia in pediatric population diagnosed with hemato-oncologic diseases presenting with febrile neutropenia at CHUK, RMH, and KFH for 5 years period. Methodology: This was a cross-sectional retrospective study over a period of 5 years at 3 referral hospitals (RMH, CHUK and KFH) which included all patients with febrile neutropenia aged less than 15 years. After data collection, Stata version 13 was used for analysis. Results: This is the 1st study describing epidemiology of microorganism in Neutropenic cancer patients in our country.138 children were included in this study; 92 patients (67%) had hematooncology diseases with ALL predominance at 50%, while 46 (33%) were non cancer patients. Overall prevalence of febrile neutropenia in our study was 0.42%. Prevalence in hematooncology was 36%. The rate of bacteremia was 37.6% (52/138). The main predominant microorganism was Gram negative which constitute 65.4% of all isolates with Escherichia coli predominance, followed by Klebsiella spp while most common gram-positive isolates were Staphylococcal aureus. Concerning antibiotic susceptibility, our study has showed that gram negatives were largely resistant to 3rd generation cephalosporins. However, 67% of S. aureus was mainly MRSA, though All E. coli isolated in our study were 100% sensitive to carbapenem. The 30-day all-cause mortality rate was 21% in all febrile neutropenic patients. The 30-day all-cause mortality rate in cancer patients with FN was 19%. Patients with severe neutropenia were at increased risks of dying comparing to those with mild or moderate neutropenia. Conclusion: Gram negative bacteremia was more common in febrile neutropenic pediatric patients. Antibiotic resistance to3rd generation cephalosporins and gentamicin suggest that carbapenems are needed for empiric treatment of febrile neutropenia. Antibiotic stewardship and microbial surveillance in our institutions need to be emphasized.