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Assessing the Impact of Pandemic-Related Social Distancing Mandates on Bloodstream Infection Rates in Children With
Rachel Offenbacher1,2, Helen S Tian3, Sara Kaswan2
1Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy.
Insights
The COVID-19 pandemic
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Children with severe neutropenia face high infection risks, necessitating avoidance of infectious disease risk factors (IDRFs).
- The COVID-19 pandemic's social distancing measures reduced exposure to environmental IDRFs, offering a unique study opportunity.
- Understanding IDRF exposure impact on bacteremia in neutropenic children is crucial for clinical guidance.
Purpose of the Study:
- To compare the incidence of fever and bloodstream infections in children with chemotherapy-induced neutropenia before and during COVID-19 pandemic lockdowns.
- To assess the influence of reduced environmental infectious disease risk factor exposure on infection rates.
Main Methods:
- Retrospective chart review of pediatric patients with neutropenia.
- Comparison of infection rates (fever, bacteremia) during two 1-year periods: pre-pandemic (March 2019-2020) and pandemic (March 2020-2021).
Main Results:
- No statistically significant difference in febrile neutropenia incidence (IRR=0.89, P=0.38) was observed.
- No statistically significant difference in febrile neutropenic bloodstream infection incidence (IRR=1.01, P=0.99) was found.
- Infection rates remained similar despite differing levels of environmental IDRF exposure.
Conclusions:
- Reduced exposure to environmental infectious disease risk factors during the COVID-19 pandemic did not significantly alter infection rates in neutropenic children.
- Further multicenter research is required to fully elucidate the risks associated with environmental exposures for neutropenic children.
- Findings may inform future clinical guidelines for managing infection risk in pediatric oncology patients.
Abstract:
Children with severe neutropenia are advised to avoid activities and public spaces where they may be exposed to potential sources of infection, due to the risk of neutropenic fever, an oncologic emergency. The influence of exposure to environmental infectious disease risk factors (IDRFs) on the incidence of bacteremia has been difficult to study. Lockdowns enforced during the COVID-19 pandemic resulted in widespread social distancing and were associated with reduced opportunities for exposure to such environmental risk factors. We performed a retrospective chart review to compare the incidence of fever and bloodstream infection in patients with chemotherapy-induced neutropenia before (March 15, 2019 to March 14, 2020) and during the COVID-19 pandemic (March 15, 2020 to March 14, 2021). Before COVID-19, there were 219 episodes of neutropenia, 79 episodes with fever, and 12 episodes with bacteremia. During COVID-19, there were 236 episodes of neutropenia, 80 episodes with fever, and 13 episodes with bacteremia. In this small retrospective study, we did not observe a statistically significant difference in the incidence of either febrile neutropenia or febrile neutropenic bloodstream infection across 2 years with differing levels of exposure to environmental IDRFs (febrile neutropenia: IRR=0.89, P=0.38; bloodstream infection: IRR=1.01, P=0.99). Further multicenter studies are needed to better define the risks of exposure to potential environmental sources of infection, which may ultimately impact provider guidance for children with severe neutropenia.
