Utility of Respiratory Pathogen Panels in Pediatric Oncology Patients with Febrile Neutropenia: A Retrospective Observational Cohort Study

Purpose Infection is a significant cause of morbidity and mortality in pediatric oncology patients, especially during neutropenia. While bacterial infections are traditionally considered the primary cause of febrile neutropenia, the growing use of respiratory pathogen panels (RPPs) for viral detection in children has not been extensively studied for its potential of beneficial impact on hospital course. Methods A retrospective cohort study of pediatric oncology patients admitted for febrile neutropenia between April 2010 and December 2022 was conducted at a medium-sized academic center. RPPs were performed on nasal swabs from 196 patients at admission, using molecular-based polymerase chain reaction with results available within 12 hours. The panel detected common respiratory viruses and atypical bacteria. Key outcomes—duration of neutropenia, fever, and length of hospital stay—were compared between patients with regard to positive and negative RPP results, respiratory symptoms and among individual pathogens. Viral trends before and after the COVID-19 pandemic were also analyzed. Results Viral infections were more prevalent than proven bacterial infections in this cohort. RPP results in patients with or without respiratory symptoms did not significantly affect the length of hospital stay. Parainfluenza viruses were associated with shorter neutropenia, fever duration, and hospital stay in univariate analysis. Logistic regression showed that community coronaviruses, bacterial infections, and leukemia diagnosis adversely affected these variables. Conclusions As the use of respiratory pathogens panel did not change hospital length of stay or overall duration of febrile neutropenia, there is insufficient data to support the use of respiratory pathogen panels routinely in children admitted with febrile neutropenia.