Development of a molecular assay for early diagnosis of pathogenic microorganisms in pediatric oncology patients with febrile neutropenia

Abstract

Neutropenia in pediatric cancer patients, immunosuppressed as a result of antitumoral therapy, has been considered a priority in medical emergencies during the past decade, requiring prompt evaluation and hospital intravenous administration of broad-spectrum antibiotics with activity against several microorganisms (bacteria) regardless the clinical condition of the child. This aggressive approach is universally recommended because approximately 60% of febrile neutropenia episodes are caused by bacterial infection. Despite this more aggressive strategy results in significant reduction of mortality from infections associated with febrile neutropenia, patients may present various adverse effects, such as antimicrobial toxicity, susceptibility to nosocomial infections by other pathogens, fungal superinfections, beyond the psychological and financial impact that can be generated by hospitalization. Recently, several studies have examined the potential as a biomarker of several inflammatory proteins to predict the risk of sepsis in adult and pediatric patients, however in children with febrile neutropenia, these studies have shown great variability with controversial results. For these reasons, we propose to develop and evaluate the introduction of an early molecular diagnosis of pathogenic microorganisms, and evaluate the impact on the care of pediatric oncology patients with episode of febrile neutropenia treated at the Hospital de Câncer Infantojuvenil de Barretos (HCIJB). The development of this project, which aims at the molecular and biochemical diagnosis and early risk stratification of pediatric oncology patients with febrile neutropenia episodes, will result in great benefits to the treatment of pediatric patients with febrile neutropenia. Thus, the results may help the establishment of a better care for these patients, leading to the proper administration of antibiotics, decrease length of hospitalization and consequently the reduction of comorbidities associated with febrile neutropenia. Furthermore, reduced time of hospitalization will open the opportunity to admit more children for care and treatment, excluding the financial impact on the healthcare system, generating a decrease of expenses for the treatment of febrile neutropenia due to early use of specific microorganism antibiotic therapy and hospitalization time. (AU)