Risk factors associated to invasive infection in children and adolescents with cancer during febrile neutropenia episodes

9046 Background: Febrile neutropenia (FN) after chemotherapy requires prompt introduction of empiric antimicrobial therapy. It has been demonstrated that FN patients do not represent a homogeneous group, and the stratification of infectious risk leads to changes in therapy. Our objectives were to evaluated the efficacy of the antimicrobial regimens used according to the FN institutional protocol and to identify risk factors related to invasive infection in children and adolescents during episodes of FN. Methods: We conducted a prospective study in the Pediatric Oncology Institute (IOP-GRAACC-UNIFESP/SP-Brazil) from March/2003 to June/2004. We analyzed 448 FN episodes in 200 patients, they were classified in high and low risk of invasive infection according to the underling disease and comorbities. Low risk patients (solid tumors, ALL and lymphomas in remission, without comorbities) were treated with oral gatifloxacin as outpatient; whereas high risk (AML, solid tumors, Lymphomas and ALL with comorbities or activity) were treated with cefepime as inpatient. Invasive infection was considered when a culture obtained from a sterile site resulted positive for bacterial and/or fungus or there were clinical and laboratory findings that strongly suggest sepsis. Results: Of 204 (45.5%) episodes treated with gatifloxacin, 72.1% obtained success without modification. Of 206 (46.0%) episodes treated with cefepime, 34.5% obtained success without modification, 38 (8.5%) patients were treated with distinct antibiotic regimen. Invasive infection was observed in 133 episodes (29.6%); 16 (3.6%) deaths occurred, all of them in the high risk group and the overall success was 84.3%. In the logistic regression analysis remained as independent risk factors: age ≤3 ys (OR: 2.3), temperature ≥38.5ºC (OR:1.6), central venous catheter (OR:1.7), underlying active disease (OR:1.6), mucositis (OR:2.4) and diarrhea (OR:2.4). Conclusions: Applying a institutional protocol, it is possible to predict the infectious risk and treat the patients individually .The observed overall success (84.3%), confirms that the therapy based in the protocol was adequate. There was no toxicity associated with gatifloxacin in this study, and no deaths in the low risk group. No significant financial relationships to disclose.