ESPN 53rd Annual Meeting

ESPN 2021


 
How Does Febrile Neutropenia Affect the Presence and Clinic of Urinary Tract Infection in Children?
Gökçen Erfidan 1 Deniz Kızmazoğlu 2 Özgür Özdemir Şimşek 1 Cemaliye Başaran 1 Seçil Arslansoyu Çamlar 3 Fatma Mutlubaş 3 Belde Kasap Demir 4 Demet Alaygut 1

1- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatrics, Division of Nephrology, Izmir, Turkey
2- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatrics, Division of Hematology and Oncology, Izmir, Turkey
3- University of Health Sciences, Izmir Faculty of Medicine, Department of Pediatrics, Division of Nephrology, Izmir, Turkey
4- İzmir Katip Celebi University, Faculty of Medicine, Department of Pediatrics, Division of Nephrology and Rheumatology, Izmir, Turkey
 
Introduction:

Febrile neutropenia (FN) is a common life-threatening infectious complication of cancer chemotherapy. In approximately 8% of pediatric FN patients, urinary tract infection (UTI) has been reported. Clinical findings of UTI may seen obscure due to low infection response, and leukocyturia may not present in FN. This study aims to analyze the urine culture (UCx) results of children who were hospitalized with FN.

Material and methods:

The episodes of FN in children hospitalized in Pediatric Hematology-Oncology Clinic during one year of period were analyzed retrospectively. Demographic, clinical and laboratory results were noted. Patients without UCx on admission were excluded. Urine samples were collected via midstream urination or urinary bag. UCx considered positive and diagnosed UTI, if ≥105 cfu/ml of a single urine pathogen was found.

Results:

Thirty-four patients with 53 FNs(79.1%) were included. In 28% of the FN episodes, a microbial growth on urine culture was detected. The most common isolation was Klebsiella spp(66.7%). The mean age in UTI group was smaller. In 80% of the episodes with UTI, the patients were younger than 4 years old. None of the patients with abdominal/flank pain had diagnosed UTI. Only one in 2 patients with dysuria had UTI. Also, in 21% of the episodes with UTI, the patients had some symptoms suggestive of other sites of infection. Leukocyte esterase and nitrite reactions were negative in all study group. There was a significant negative correlation with the frequency of UTI and neutropenia level. C-reactive protein level was found lower in the UTI group.

Conclusions:

In this study, the frequency of UTI in FN episodes was three times higher compare to literature. The most commonly isolated microorganism was Klebsiella spp. During FN episodes, most patients with UTIs didn’t have specific symptom, and pyuria may not present. Therefore, if UCx is not taken routinely, the diagnosis can easily be missed.