Background: Fever in severe chemotherapy induced neutropenic patients is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimen. Objective: The aim of this study is identification of risk factors of fever in neutropenic children with acute lymphoblastic leukemia. Methodology: This observational study was carried out in the department of pediatric haematology and oncology department during the period of 1st February 2013 to 31st January 2014. Patients detailed history and behavioral pattern regarding the supportive management (neutropenic diet, use of acriflavine solution, nystatin oral solution, mouth wash with povidone iodine), total duration of hospital stay, duration of neutropenia, number of attendants during hospital stay were recorded. Blood, urine and wound swab culture was done. Result: Out of 40 patients most of the studied child were in induction phase of therapy. The mean hospital stay was 8.56±6.75 days and mean number of attendants with each patient was 2.02±0.65. Majority of the patient were on neutropenic diet and freshly cooked food (87.5%). This study shows a large portion (52.5%) of the studied population did not use acriflavine as per advice. It also revealed majority of the child did not use povidone iodine mouth wash (52.5%) and nystatin (47.5%). as per advice. A total of 10 patients (25%) revealed growth of pathogens. Among them blood culture was positive in 4 patients, urine culture was positive in 3 patients and wound swab culture was positive in 3 patients. This study showed that major portion (65%) of the febrile neutropenic child suffered from malnutrition. Conclusion: This study showed that majority of the patient did not properly follow the advice regarding behavioral and supportive management. Duration of hospital stay and number of attendants were also high. Malnutrition was present in a large portion of the child.

Background: Acute lymphoblastic leukemia (ALL) is the commonest malignancies in childhood. Common obstacle in the treatment of ALL is febrile neutropenia and its complications. Objectives: To identify bacteria causing infection, their isolation rate and antibacterial sensitivity pattern in hospitalized febrile neutropenic children with ALL in different cycle of chemotherapy. Methodology: This observational study conducted in 2014 - 2015 in the department of paediatric haematology and oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Sixty febrile neutropenic episodes from 52 diagnosed cases of ALL aged 0 to18 years were included. Complete blood count, blood culture, urine microscopy and culture, serum alanine aminotransferase, serum creatinine were done in every patient. X-ray chest, stool microscopy and culture, pus, wound, throat and aural swab for culture & sensitivity were done in selective patient. Results: Bacterial infection was confirmed by culture in 15 (25%) episodes from 60 febrile neutropenic episodes. Fifteen (25%) organisms were isolated from the study subjects from sample of blood (60%), pus (13.3%), aural swab (13.3%), wound swab (6.7%) and throat swab (6.7%) respectively. All isolates were gram negative. The organism isolated were Klebsiella spp. 5 (33.31%), E. coli 4 (26.7%), Acinetobacter 3 (20%), Pseudomonas 2 (13.3%) and only one (6.7%) Enterobacter species. All the isolates of the Klebsiella spp., E. coli and Acinetobacter spp. were resistant to amoxicillin. All isolated E. coli were resistant to cotrimoxazole, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin, Acinetobacter spp. Isolated were 100% sensitive to imipenem, colistin sulphate & piperacillin-tazobactam and resistant to cotrimoxazole and cephradine. All Pseudomonas spp. showed 100% sensitivity to imipenem, amikacin, ciprofloxacin & colistin and resistances to ceftazidime. Conclusion: The species of Klebsiella were the predominant causative bacterial agent followed by Escherichia coli, Acinetobacter spp, pseudomonas spp. and Enterobacter spp. They showed resistance to commonly prescribed antibiotics ceftazidime, gentamicin, ceftriaxone & ciprofloxacin and sensitive to imipenem, colistin-sulphate & piperacillin-tazobactam.