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4th Edition of World Congress on Infectious Diseases

June 21-22, 2023 | Rome, Italy

June 21 -22, 2023 | Rome, Italy
Infection 2023

Josh Nathan L. Ngai

Speaker at World Congress on Infectious Diseases 2023 - Josh Nathan L. Ngai
St. Luke's Medical Center, Philippines
Title : Clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenia patients with hematologic malignancies in a private tertiary hospital in the Philippines


Introduction: Febrile neutropenia is a major cause of morbidity and mortality in children with hematologic malignancies. It presents as a serious, potentially fatal condition complicating cancer treatment associated with significant morbidity and mortality. To date, established national guidelines for its management in the Philippines remains lacking.

Methods: A cross-sectional analysis of medical records which included Filipinos ages 0-18 years old diagnosed with hematologic malignancies admitted for or developed FN during admission from June 2016-June 2022 in a tertiary hospital was done. Convenience sampling of charts for age, sex, underlying malignancy, stage of treatment, interval from last chemotherapy, site of infection, presence of central line, initial antibiotic therapy, culture positivity and isolates done. Incomplete charts were excluded. The relationship between clinical and microbiologic profile with outcomes were analyzed using T-test and Chi-square test. Significance was set at p<0.05.

Results: Two hundred sixty-seven episodes of febrile neutropenia were included. Patients had a mean age of 8.3 years with a male preponderance (59% male vs. 41% female). The most frequent underlying disease was acute lymphoblastic leukemia (61%). Episodes occurred mostly during the induction (40%) and consolidation phases (28%) of chemotherapy. Most (65%) had an absolute neutrophil count (ANC) of <100/mm3. A central line catheter was present in 157 (59%) episodes with 139 (52%) having an implanted port (CVAD). There was no identifiable focus of infection in 52% of cases. Gram negative bacteria, particularly Klebsiella pneumoniae (13%) and Escherichia coli (11%) were the most commonly isolated organisms. Most patients (88%) recovered. Age >10 years, male sex, acute myelogenous leukemia diagnosis, relapse disease, ANC <100/mm3, presence of a central line and central line associated infection were found to be significantly associated with duration of hospital stay (p <0.05). Presence of a central venous line was likewise found to be the most significant factor associated with mortality.

Conclusion: The results of this study may provide baseline information that can be used to help formulate guidelines for the diagnosis and management of febrile neutropenia in children with hematologic malignancies that is appropriate for the Philippine setting.

Audience take away: 

• Although the study was done in the Philippines, there are several other developing countries with similar healthcare systems. In that regard, delegates from such developing countries may be able to further improve their own medical approaches to febrile neutropenia in pediatric hematologic malignancies.
• This study serves as a snippet of the microbiological epidemiology of a single medical center in a resource limited country. The findings in this study may help improve in infection-related outcomes and devising better hygiene control measures of not only the institution where the study was conducted but also in other local hospitals.
• The study further contributes to the documentation and determination of risk factors affecting outcome in not just hematologic malignancies but also other pediatric malignancies with febrile neutropenia.
• This study may also contribute in devising local guidelines for targeted therapy based on risk criteria, alleviating not only the cost of cancer care but also of antimicrobial therapy.


Dr. Josh Ngai graduated with a bachelor of science degree in Biology from the Ateneo De Manila University, Philippines in 2013. He received his Doctorate of Medicine degree from the St. Luke’s Medical Center College of Medicine, Philippines in 2018. He then went on to complete his residency training in Pediatrics at St. Luke’s Medical Center – Quezon City, Philippines in 2022.