Microbiology and mortality of pediatric febrile neutropenia in El Salvador.

BACKGROUND: Febrile neutropenia (FN) and infection-related mortality are major problems for children with cancer in low-income countries. Identifying predictors for adverse outcome of FN in low-income countries permits targeted interventions. We describe the nature and predictors of microbiologically documented infection (MDI) and mortality of FN in children with cancer in El Salvador. METHODS: We examined Salvadoran pediatric oncology patients admitted with FN over a 1-year period. Data were collected prospectively. Demographic treatment and admission-related variables were examined as predictors of outcomes. RESULTS: Hundred six FN episodes among 85 patients were included. Twenty-three of 106 episodes (22%) were microbiologically documented; 13 of 106 episodes (12%) resulted in death. Gram-positive and gram-negative organisms were isolated in 14 of 23 and 11 of 23 specimens; polymicrobial infections were common (11 of 23 episodes of MDI). Older age decreased the MDI risk [odds ratio (OR) per year=0.87 95% confidence interval (CI) 0.75-0.99; P=0.04] while increasing number of days since the last chemotherapy increased the risk (OR=1.03 per day 95% CI 1.01-1.04; P=0.002). Pneumonia diagnosed either clinically (OR=6.6 95% CI 1.8-30.0; P=0.005) or radiographically (OR=5.5 95% CI 1.7-18.1; P=0.005) was the only predictor of mortality. CONCLUSIONS: In El Salvador polymicrobial infections were common. Pneumonia at admission identified children with FN at high risk of death; these children may benefit from targeted interventions.