For decades, febrile neutropenia (FN) in cancer patients has been treated with utmost urgency, necessitating immediate initiation of empirical broad spectrum intravenous antibiotics. Recently, it has become evident that neutropenic cancer patients are not a homogeneous group and that practice guidelines may vary on their risk status. Thus, this study aimed to evaluate the significance and risk factors predisposing to a positive blood culture in febrile pediatric cancer patients with chemotherapy-induced FN, and to study the impact of nosocomial bacteraemia on clinical course and outcome of these febrile episodes. A prospective cohort study included febrile episodes occurring in a large group of pediatric patients with chemotherapy-induced FN at the National Cancer Institute over a period of one year. Blood cultures were drawn and micro-organisms were identified. Among 729 episodes of fever and neutropenia recorded in 475 patients, bacteraemia was detected in 46.2% of episodes of which 56% showed a lengthy episode (≥ 7days). Coagulase-negative Staphylococci (CoNS) were associated with the least complications while Gram negative bacteraemia (GNB) were associated with the most severe blood stream infections (BSI). The overall mortality rate was 7.5% (n=55) and was significantly higher among BSI (11%) than those episodes that were not bacteraemic (4.6%). In addition, the mortality was significantly higher in GNB and mixed BSI, than in Gram positive BSI with p< 0.001.  Logistic regression determined BSI, a lengthy episode, younger age of child with a relapsing tumor and presence of a canula as independent factors affecting mortality and thus prognosis of the child with FN.Results of the study suggest significant differences in the clinical characteristics of BSI by the different classes of micro-organisms in pediatric cancer patients with chemotherapy-induced FN. BSI profoundly influences course and outcome of episodes. Continuous multi-disciplinary surveillance of BSI is warranted in this group of patients to develop strategies for antimicrobial resistance control and treatment of infectious complications.