# Incidence of Bloodstream Infections in Pediatric Patients with Cancer during Febrile Neutropenia: A Retrospective Study

## TL;DR

This study finds that children with AML undergoing chemotherapy, especially with high-dose cytarabine, are at higher risk for bloodstream infections during febrile neutropenia.

## Contribution

The study identifies AML and high-dose cytarabine as significant risk factors for bloodstream infections in pediatric cancer patients.

## Key findings

- AML patients had the highest BSI incidence (17%) compared to other cancers.
- During febrile neutropenia, AML patients had a 22% BSI rate versus 7%-13% in others.
- High-dose cytarabine in AML patients was linked to a 30% BSI incidence.

## Abstract

Bloodstream infections (BSIs) are a major concern in pediatric patients with cancer, especially during episodes of febrile neutropenia (FN). In this study, we aimed to evaluate the incidence of BSI across various pediatric malignancies and identify cancer subtypes associated with a heightened risk of BSI.

This single-center, retrospective cohort study analyzed the electronic medical records of pediatric patients with cancer treated between April 2012 and March 2023. Eligible patients included those diagnosed with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), lymphoma, brain tumors, and solid tumors. For each chemotherapy course, we assessed BSI incidence and FN episodes.

This study included 152 pediatric patients who underwent 829 chemotherapy courses. The cohort comprised 21 patients with AML, 52 with ALL, 10 with lymphoma, 26 with brain tumors, and 43 with solid tumors. Compared to other cancer types, the AML group exhibited the highest proportion of BSI across all chemotherapy courses (17% vs. 4%-7%). During FN episodes, the AML cohort had a significantly higher BSI incidence (22%) than other groups (7%-13%). Notably, chemotherapy courses involving high-dose cytarabine (HD-CA) had a substantially higher BSI incidence (30%) among the patients with AML than courses without HD-CA (2%).

Patients with AML have the highest risk of BSIs in pediatric malignancies, particularly during FN episodes. In addition, our findings highlight an association between BSIs and HD-CA use in patients with AML.