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Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and
E P Baorto1, V M Aquino, C A Mullen
1Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA.
Insights
Children with cancer and fever/neutropenia with an absolute monocyte count (AMC) of at least 155 cells/mm³ have a low risk of bacteremia. These patients may be candidates for outpatient management, reducing hospitalizations.
Area of Science:
- Pediatric Oncology
- Infectious Disease Management
- Hematology
Background:
- Fever and neutropenia in pediatric oncology patients traditionally requires hospitalization for intravenous antibiotics.
- Outpatient management strategies are emerging for lower-risk patient cohorts.
- Identifying reliable predictors of bacteremia is crucial for risk stratification.
Purpose of the Study:
- To identify clinical and laboratory parameters associated with a low risk of bacteremia in children with malignant disease presenting with febrile neutropenia.
- To evaluate specific admission parameters and their cut-off values for predicting bacteremia risk.
- To assess the potential for outpatient management in select pediatric oncology patients.
Main Methods:
- A multicenter, retrospective cohort study of 1171 episodes of febrile neutropenia in children over one year of age with malignant disease.
- Analysis of admission parameters including absolute neutrophil count (ANC), absolute phagocyte count (APC), absolute monocyte count (AMC), platelet count, and temperature.
- Statistical evaluation using odds ratios to determine parameters associated with the lowest risk of bacteremia and adverse outcomes (ICU admission or death).
Main Results:
- Bacteremia occurred in 14% of episodes (189/1171).
- Adverse outcomes (ICU admission or death) were rare (0.9%, 11/1171), primarily in patients with AMC < 30 cells/mm³.
- A significantly lower bacteremia frequency (6.1%) was observed in patients with an admission AMC ≥ 155 cells/mm³; none required ICU admission or died.
- No statistically significant association was found between ANC, APC, temperature, or platelet count and reduced bacteremia risk.
Conclusions:
- Adverse outcomes from bacteremia are infrequent in pediatric oncology patients with febrile neutropenia managed with parenteral antibiotics.
- Pediatric oncology patients with febrile neutropenia and an AMC ≥ 155 cells/mm³ demonstrate the lowest risk for bacteremia.
- These patients with high AMC values represent a potential cohort for outpatient management, optimizing care and resource utilization.
Background:
Traditionally, children with malignant disease who present with fever and neutropenia are hospitalized for parenteral antibiotics. More recently, outpatient strategies have been proposed for lower risk cohorts of such patients. The authors sought to identify clinical and laboratory parameters that are associated with a low risk of bacteremia in children with malignant disease who presented with febrile neutropenia.
Methods:
A multicenter, retrospective cohort of children with malignant disease and fever with neutropenia was established in three pediatric oncology centers over a 5-year period. A total of 1171 episodes of febrile neutropenia (absolute neutrophil count [ANC] < 500 cells per mm(3)) were identified in children with malignant disease age > 1 year. The endpoints examined were 1) bacteremia and 2) intensive care unit admission or death related to bacteremia. The odds ratio was used to determine which of the following admission parameters and cut-off values were associated with the lowest risk for bacteremia: ANC, absolute phagocyte count (APC), absolute monocyte count (AMC), platelet count, and admission temperature.
Results:
A total of 189 episodes of bacteremia were identified among the 1171 episodes of febrile neutropenia (14% bacteremia). Only 11 of 1171 episodes (0.9%) resulted in intensive care unit admission, and 3 of these patients died. All 11 patients had an AMC < 30 cells per mm(3). The lowest frequency of bacteremia (6.1%) occurred in the children with an admission AMC of > or = 155 cells per mm(3). None of the patients identified as low risk by AMC required an intensive care unit admission or died. No level of ANC, APC, temperature, or platelet count was associated with a statistically significant decrease in the risk for bacteremia in the patient population.
Conclusions:
Adverse outcomes due to bacteremia are infrequent in pediatric oncology patients who present with fever and neutropenia are treated with parental antibiotics. Patients with fever and neutropenia and an AMC value of > or = 155 cells per mm(3) have the lowest risk for bacteremia and may be potential candidates for outpatient management.
