Urinary Tract Infection As A Predictor Of Poor Prognosis In Pediatric Patients With Severe Febrile Neutropenia Related To Chemotherapy

The diminished inflammatory response in patients with febrile neutropenia secondary to chemotherapy makes it hard to discard a urinary tract infection based solely on the physical evaluation of the patient and basic urine laboratory tests. This could lead to false negative results with serious consequences to the patients. Objective: To define if the urinary tract infection is a high-risk predictor of severe complications in the pediatric patient with febrile neutropenia-related with chemotherapy and to establish the diagnostic significance of normal urine sediment in the initial study. Methods: A Cross-sectional study of diagnostic technology. We included children with ages from 2 to 18 years old, with severe febrile neutropenia related to chemotherapy, we compared patients with and without urinary tract infection and evaluated poor prognosis outcomes and analyzed the diagnostic efficiency of urinalysis. Results: We included 107 episodes, UTI (urinary tract infection) was diagnosed in 8 episodes (16%), there was a higher frequency of nitrites, esterase and pyuria in the urinary tract infection episodes, (p<0.001), three episodes of UTI had normal urinalysis, we found a low sensitivity for all components of urinalysis with greater specificity, NPV and LR + for all components alone or evaluated associations, with a better performance for nitrites. From the outcomes assessed we found more clinical sepsis, need of ICU (intensive care unit) and mortality in patients with urinary tract infection (p=0.023, p=0.01 y p<0.001). Conclusion: The initial evaluation in this type of patient should include urinalysis and urine culture; we should consider any sign of inflammation in the urinalysis as pathologic; UTI is a bad prognosis factor in patients with fever and neutropenia. Image: Frukosten av Amalia Lindegren 1866. Public Domain Image. https://commons.wikimedia.org/wiki/File:Frukosten_av_Amalia_Lindegren_1866.jpg