OBJECTIVES We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC < 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79–0.93; p < 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01–1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01–1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02–1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

Background: Over the last two decades the increasing incidence of benign liver tumors has led to the expanded need for clinicians to make therapeutic decisions regarding the utilization of open, minimally invasive and ablative techniques. The purpose of this study was to compare outcomes of the management of benign liver disease based on operative approach and pathology. Methods: Patients aged 18 years or older who underwent liver surgery for benign liver tumors from 2010 to 2014 were identified in the Nationwide Readmissions Database. Patients were compared based on liver pathology, resection versus ablation, and an open versus laparoscopic/robotic approach. The outcomes of interest were in-hospital mortality, prolonged length of stay (LOS) >7 days, and readmission within 30-days. Univariable analysis was performed for these outcomes and multivariable logistic regression was performed using the variables with a p-value <0.05 on univariable analysis. Results: There were 6,173 patients undergoing surgery for benign hepatic tumors in the US during the study period. The overall mortality rate was 0.3%, a prolonged LOS was found in 14.7%, and readmission within 30 days occurred in 8.1%. An increased risk for mortality was found with hemangioma (OR 12.34, p = 0.03) and congenital cystic disease (OR 11.43, p = 0.03). Resection with ablation was associated with an increased risk of prolonged LOS (OR 2.22, p < 0.01). Patients treated with ablation alone were at decreased risk for readmission (OR 0.59, p < 0.01). Conclusion:The surgical management of benign liver tumors continues to be a safe and effective option. Minimally invasive techniques are associated with a decreased length of stay and ablative techniques are associated with decreased readmission rates.