Predicting the risk of bacteremia in childen with fever and neutropenia.

TLDR

The study aimed to identify admission‑time factors predicting bacteremia in pediatric cancer patients with fever and neutropenia and to suggest that these factors could guide less intensive or outpatient antibiotic therapy. The authors prospectively studied 115 fever‑neutropenia episodes in 72 pediatric cancer patients, using exploratory analysis and recursive partitioning on admission temperature and absolute monocyte count to derive risk cutpoints, and validated the classification with 57 additional episodes. Among the episodes, 21% had bacteremia, with none in the low‑risk group, 19% in the intermediate‑risk group, and 48% in the high‑risk group, yielding an odds ratio of 4.4 for high versus intermediate risk, thereby defining three distinct bacteremia risk levels based on admission temperature and monocyte count.

Abstract

PURPOSE We sought to identify factors assessable at the time of admission for fever and neutropenia that predict bacteremia in children with cancer. PATIENTS AND METHODS One hundred fifteen consecutive episodes of fever and absolute neutrophil count (ANC) less than 500/microliter in 72 children with cancer were studied prospectively to determine the risk of bacteremia using data assessable at the time of presentation. After exploratory analysis identified admission temperature and absolute monocyte count (AMoC) as the strongest predictive factors, recursive partitioning was used to determine cutpoints for these variables that resulted in discrimination between episodes associated with a lower or higher risk of bacteremia. RESULTS There were 24 episodes of bacteremia (21% of episodes). Episodes were grouped using the cutpoints for AMoC and temperature: 17% were classified as low risk for bacteremia (AMoC > or = 100/microliter), 65% as intermediate risk (AMoC < 100/microliter and temperature < 39.0 degrees C), and 18% as high risk (AMoC < 100/microliter and temperature > or = 39.0 degrees C). No episodes classified as low risk were associated with bacteremia; 19% of intermediate-risk and 48% of high-risk episodes were associated with bacteremia. The odds ratio of bacteremia for the high-risk versus the intermediate-risk group is 4.4 (95% confidence interval, 1.6 to 12.9). The risk classification was validated using data from 57 different episodes of fever and neutropenia treated in the same hospital. CONCLUSION Three levels of risk for bacteremia are defined using the AMoC and temperature at the time of admission for fever and neutropenia. Trials now should be conducted to test whether these factors may be used to assign some children to less intensive or outpatient antibiotic therapy at the time of presentation with fever and neutropenia.