Fever and bacteremia in children and adolescents with acute lymphoblastic leukemia

The medical records of 318 children and adolescents with acute lymphoblastic leukemia (ALL) were reviewed to determine the relationship between the occurrence of fever, a positive blood culture, and the absolute neutrophil count (ANC) during induction, remission maintenance, and bone marrow relapse. On the day of diagnosis of ALL, almost one-third of the patients had a temperature higher than 38.5 degrees C, but only three (4.1%) had positive blood cultures. Following the initiation of induction chemotherapy, many patients had febrile episodes. Forty-six percent of the blood cultures obtained during this period were positive. Only patients with an absolute neutrophil count of 1000/mm3 or less were at risk of a positive blood culture during induction. Thirty-four percent of the admissions during remission maintenance for fever were associated with pneumonia. One-half of the episodes of pneumonia occurred during the first 150 days following the diagnosis of ALL. No patient with pneumonia during remission maintenance had a positive blood culture. Eighteen percent of the blood cultures obtained from patients admitted during periods of bone marrow relapse were positive. Gram-positive organisms predominated during induction, whereas gram-negative organisms predominated during periods of bone marrow relapse.