Objective: Though there is now better survival percentage in pediatric patients with cancer, neutropenic fever (FN), is still a large medical problem in such population. In addition, presence of systemic infections in FN patients will worsen their outcome. This study aims to investigate the most prominent prognostic factors in FN patients with systemic infections. 
Methods: Retrospective cohort from 2015-2017. 
Results: A total subjects of 180 patients (57.8% boy) met this study criteria. More than half was diagnosed >5 years old and 74% of them had non-solid tumors, mainly only contracted FN episode once, even about 52% of chemotherapy was high-risk/intensity chemo. Furthermore, only 10% of patients were malnourished. There were 41 subjects (23%) who passed away; blood culture was positive in 27% of them (vs. 8% from survived patients, p=0.001). Central venous catheter worsened the outcome while using granulocyte-macrophage colony-stimulating factor (GM-CSF) improved FN outcome (p 0.002 and 0.021, respectively). Nevertheless, peak and duration of fever, hemoglobin level, neutrophil count, and types of chemo were not statistically significant. Definitive antibiotics was also not a prognostic factor (50% in survived subjects, 51% in deceased subjects, p 0.863). 
Definitive antibiotics given to the patients in this study did not improve the outcome. We can consider that: (1) the standard empirical antibiotics are good enough to cover the pathogen because it matches antibiotic resistance pattern of prior data; (2) change of empirical antibiotics before culture result is more important for patients’ survival. 
Conclusions: Central venous catheter and GM-CSF in solid tumor contribute to outcome in systemic infected FN patients. Positive blood culture is a marker of poor prognosis. Aggressive empirical antibiotics are also a mainstay therapy for such patients. Nevertheless, further study for other factors is needed.