Febrile neutropenia in children and adolescents with acute myeloid leukemia during induction therapy.

Background: Febrile neutropenia (FN) is a serious and potentially life-threatening complication in children with acute myeloid leukemia (AML), particularly during induction chemotherapy. However, data from low- and middle-income countries remain limited. Methods: We conducted a retrospective study including children and adolescents with newly diagnosed AML who experienced at least one FN episode during induction therapy at Aziza Othmana Hospital, Tunis, Tunisia. Results: Among 63 patients with AML, 55 (87.3%) experienced 82 FN episodes. No patient received antibacterial or antifungal prophylaxis. Clinically documented infections (CDI) accounted for 53.6% of episodes, fever of unknown origin for 25.7%, and microbiologically documented infections (MDI) for 20.7%. The gastrointestinal tract was the most frequent site of infection (50%), followed by the respiratory tract (31.8%). Blood cultures yielded predominantly Gram-negative bacilli and Gram-positive cocci in similar proportions. Multidrug-resistant Gram-negative bacteria were identified in five episodes. Clinical outcomes were favorable in 77 episodes (94%), with a median time to defervescence of four days. Five patients died, resulting in a FN-related mortality rate of 9%. Intensive care unit (ICU) admission and presence of sepsis/septic shock were associated with mortality in univariate analysis. Conclusion: FN remains a major cause of morbidity and mortality during AML induction therapy. Early recognition, prompt antimicrobial treatment, and improved access to microbiological diagnostics may improve outcomes in resource-limited settings.