1534. Prevalence and Outcome of Neutropenic Enterocolitis Among Pediatric Acute Myeloid Leukemia Patients: A Developing Country Experience

BACKGROUND: Neutropenic enterocolitis (NEC) is a life-threatening disease with substantial morbidity and mortality, seen primarily in patients with hematologic malignancies. The frequency of NEC has increased with the widespread use of chemotherapeutic agents such as the taxanes, which cause severe gastrointestinal mucositis. METHODS: This was a retrospective study at the National Cancer Institute, Cairo University. The computerized records were screened for ultrasound or computerized tomographic scan requests for abdominal pain for all acute myeloid pediatrics inpatients (2012–2016). Retrospective case note analysis was used to collect clinical data for patients with features of Typhlitis. D 30 morbrtality was reported. RESULTS: The incidence of NEC among our inpatients was 24% (49/203). Forty-three children had radiologically confirmed typhlitis, and six had clinical features alone. Most (93%) patients were profoundly neutropenic (ANC <100). All of the patients were subjected to conservative management. All of them needed ICU admission. Eighteen children had a variable period of bowel rest, including 12 patients who were supported with total parenteral nutrition. Three patients had laparotomy that revealed extensive colonic bowel necrosis (1), perforated bowel loop (1), and a perforated appendix (1).Two out of three cases of Laparotomy were diagnosed with Mucormycosis. 30-Days mortality was 44.8% (22/49).Relapsing typhlitis in subsequent courses was observed in 6/27 (22%) patients. Fulminant Gram-negative sepsis without surgical intervention was the leading cause of death in this cohort. CONCLUSION: The diagnosis of typhlitis was based on clinical features, supported by radiologic evidence in almost half of the study group. Surgical intervention should be reserved for specific complications or where another surgical pathologic condition cannot reasonably be ruled out. Though rare, fungal infection should be suspected specially in cases with worsening signs of typhlitis despite broad antimicrobial coverage. DISCLOSURES: All authors: No reported disclosures.