Utility of Respiratory Pathogen Panel in Pediatric Oncology Patients
with Febrile Neutropenia: A Retrospective Observational Cohort Study
Abstract
Background Infection is a major cause of morbidity and mortality
in pediatric oncology patients, particularly during periods of
neutropenia. While bacterial infections are traditionally considered the
most common cause of febrile neutropenia, the increasing use of
respiratory pathogen panels (RPPs) for viral detection may challenge
this view. Methods A retrospective cohort study was conducted on
pediatric oncology patients admitted for febrile neutropenia between
2010 and 2022 at a medium-sized academic center. An RPP was performed on
nasal swabs from 196 patients at admission and analyzed using
molecular-based polymerase chain reaction. Results were available within
12 hours. Pathogens included in the assay were common respiratory
viruses and atypical bacteria. Comparison of the duration of
neutropenia, duration of fever, and length of stay was made between
patients who had a positive respiratory panel and those who did not, as
well as each individual pathogen. Additionally, the frequency of viruses
before and after the COVID-19 pandemic was analyzed. Results
Viral infections were more common than bacterial infections in this
cohort. The effect of the RPP on the length of stay was not
statistically significant. Parainfluenza viruses were associated with a
longer duration of neutropenia, duration of fever, and length of stay.
Logistic regression analysis revealed that community coronaviruses,
bacterial infections, and a diagnosis of leukemia also impacted these
variables. Conclusions Utilization of RPPs may be useful in the
workup of febrile neutropenia by providing data for risk evaluation,
predicting clinical outcomes, detecting viruses to implement barrier
precautions early, and potentially adjusting antimicrobial usage.