الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Fever with neutropenia is common complication of the intensive chemotherapy regimens given for pediatric neoplastic diseases. Risk of infection and infection related mortality increase in direct proportion to degree and duration of neutropenia. Fever with neutropenia generally requires immediate hospitalization and broad spectrum antibiotic therapy. (Ozkaynak et al., 2005). The present recommendations for empirical antibiotic treatment in oncology patients with fever and neutropenia are monotherapy (cabapenem or third or fourth generation cephalosporin) or a combination of , lactamase inhibitor antibiotic plus an aminoglycoside. The effectiveness of these regimens had been documented in many studies, but no single regimen was proved to be clearly superior to others (Greenberg et al., 2005). For pediatric patients, studies on identification of risk factors for invasive bacterial infections and studies on selective management are scarce (Aquino et al., 1997), although the identification of clinical and laboratory predictors of causes of morbidity and mortality in febrile neutropenic patients with cancer is crucial to early treatment (ElMahallawy et al., 2005). Aim of work: To review the organisms causing infections in pediatric febrile neutropenic patients of Mansoura university pediatric oncology unit. To analyze the antibiotic susceptibility of these organisms. To test the various risk factors in pediatric febrile neutropenic patients. To assess the patterns of CD4 & CD8 in febrile neutropenic children and their relation to infection. Methods: thorough history including Evaluation of the socioeconomic status, Full clinical examination, Full clinical examination, Isolation of CD4+and CD8+ T cells, Cultures for infection screening Results: For this purpose 37 patients with febrile neutropenia were included (22 males and 15 females) in addition to 13 children with afebrile neutropenia and 20 children who were afebrile non neutropenic. Oral mucositis, respiratory tract infections and enteritis were the most common sites of detected infection (21.5%, 16.2%, and 10.8% respectively). The incidence of gram positive organisms was predominant in the febrile neutropenic children (64.7%) with Staph. spp. being the most common pathogen (29.4%). Gram negative organisms represented 29.4% of the positive cultures with Pseudomonas spp. being the most common pathogen (11.8%). Candida albicans was encountered in only 5.9% of positive cultures in the febrile neutropenic children. Gram positive organisms were more sensitive to vancomycin (72%), amoxycillinflucloxacillin (63%) and gentamycin (54%), while gram negative organisms were most sensitive to amikacin, cefoperazone, imipenem and gentamycin. Conclusion: Oral mucositis, respiratory infections and enteritis were the most common sites of infection in febrile neutropenic children while no focus was detected in 54.1% of patients. Gram positive organisms were the most common isolated pathogens especially Staph. spp. Amoxycillinflucloxacillin, vancomycin, gentamycin, amikacin and cefoperazone were the most effective antimicrobials in vitro and may be considered in empiric therapy in febrile neutropenic patients. Total leucocytic count, absolute neutrophil count and duration of hospital stay may be risk factors for fever developed in neutropenic patients. Tcell deficiency may be a contributor to infection in the neutropenic children with cancer.