Children with severe aplastic anemia (SAA) who have episodes of febrile neutropenia (FN) are more likely to have Gram-negative bacteria infections, according to research published in the Journal of Pediatric Hematology/Oncology.

In this prospective observational study, researchers aimed to investigate the clinical profile, microbiologic spectrum, and resistance patterns of FN, as well as etiology and patient history. A total of 38 episodes of FN were examined in 31 children (median age, 6.67 years) with SAA who were seen at a tertiary care center in India. Of the 31 participants, 1 child had acquired Fanconi anemia.

Over half (54.8%) of FN episodes occurred in patients receiving immunosuppressants (ATG and cyclosporine therapy), while the remaining participants experienced FN episodes before they were ever prescribed immunosuppressive therapy. Clinically documented infections, microbiologically documented infections, bacteremia, and invasive fungal infections accounted for 55.26%, 39.47%, 34.21%, and 15.78% of episodes, respectively.

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The most common area of infection among clinically documented infections was the lower respiratory tract (23.68%). Of bacterial isolates from patients with FN episodes, 62.5% were Gram-negative. The most common Gram-negative species was Klebsiella pneumoniae, while the most common among Gram-positive bacteria was coagulase-negative Staphylococcus.

While resistance varied by species, it was commonly noted across Gram-negative bacteria. Resistance was high against cephalosporins, except for Acinetobacter species, which showed 100% sensitivity to ceftazidime. Approximately half of the Gram-negative organisms reportedly showed resistance to aminoglycosides, piperacillin-tazobactam, and/or carbapenem; however, sensitivity to colistin reached 100% across Gram-negative isolates. Gram-positive isolates showed relatively high sensitivity rates to antibiotics, with 100% sensitivity to both vancomycin and clindamycin.

Candida and Aspergillus were the most common pathogens in invasive fungal infections; 4 of 5 patients with invasive fungal infections died. The overall mortality rate was 42%.

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The investigators expressed concern regarding the number of strains showing resistance. “FN continues to be the major contributing factor in morbidity and mortality in children with SAA,” wrote the investigators in their report. They recommended local assessments of dominant pathogens, and their sensitivity characteristics, in order to determine the most appropriate empiric antimicrobial therapy for FN in a given locality.


Samanta A, Chandra J, Kaur R, Anand R, Shukla S, Mandal P. Clinical profile and microbiologic spectrum of febrile neutropenic episodes in children with severe aplastic anemia. J Pediatr Hematol Oncol. 2020;42(3):193-197.