Bacteremia in nonneutropenic pediatric oncology patients with central venous catheters in the ED

Moskalewicz, Risha L.; Isenalumhe, Leidy; Luu, Cindy; Wee, Choo Phei; Nager, Alan L.

doi:10.1016/j.ajem.2016.09.028

Cited by 20 publications

(57 citation statements)

References 24 publications

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“…A total of 646 titles and abstracts were reviewed, of which 83 full‐text articles were retrieved. From this, 16 relevant articles, describing 15 studies, were identified for inclusion in this review (Figure ) . No dedicated NNF treatment guidelines were identified in this search.…”

Section: Resultsmentioning

confidence: 99%

“…The inclusion criteria across the studies included in this review varied. Notably, nine (60%) studies only included patients with a central venous catheter (CVC) in situ . The type of CVC also varied across the studies with implanted ports more common in six, whereas tunneled external CVC were more common in two, albeit older, studies (type not reported in 7).…”

Section: Resultsmentioning

confidence: 99%

“…Across the 15 studies, the pooled average rate of bacteremia was 8.2% (95% confidence interval [CI], 5.4%–12%) over 4106 NNF episodes (Figure ). Overall, 11 studies reported a bacteremia rate less than 10% . In studies that excluded common commensals unless cultured more than once, the bacteremia rate ranged from 4% to 10%, pooled average 6.3% (95% CI, 4.6%–8.5%) .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Nonneutropenic fever in children with cancer: A scoping review of management and outcome

Allaway

Phillips

Thursky

et al. 2019

Pediatric Blood & Cancer

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To date, very few studies have addressed nonneutropenic fever (NNF) in children with cancer, and there are no consensus guidelines. This scoping review aims to describe the rate of bacteremia, risk factors for infection and management, and outcomes of NNF in this population. Across 15 studies (n = 4106 episodes), the pooled‐average bacteremia rate was 8.2%, and risk factors included tunneled external central venous catheter, clinical instability, and higher temperature. In two studies, antibiotics were successfully withheld in a subset of low‐risk patients. Overall outcomes of NNF appear favorable; however, further research is required to determine its true clinical and economic impact.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Nonneutropenic fever in children with cancer: A scoping review of management and outcome

Allaway

Phillips

Thursky

et al. 2019

Pediatric Blood & Cancer

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“…If accounting for patients with CVCs alone, the incidence of positive blood culture in our study was 3.0% (6/203). Previous studies have proposed that characteristics such as height of fever, externalized CVCs, and absence of viral respiratory symptoms are associated with bacteremia. Our study demonstrated no significant differences in clinical variables between patients with and without positive blood cultures aside from rate of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of bacteremia in this population is reportedly 10% to 16.1% . In contrast, there are currently no consensus guidelines for the management of patients presenting with fever and nonneutropenia (FNN), in whom the incidence of bacteremia ranges 3.1% to 10.9% in recent studies . Historically, patients with FNN had been treated similarly to neutropenic patients with empiric antibiotics .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Muller

Morgan

2018

Pediatric Blood & Cancer

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There are no consensus guidelines for management of pediatric oncology patients presenting with fever and nonneutropenia, with limited research into the outcomes of withholding empiric i.v. antibiotics. We conducted a prospective cohort study assessing the safety and efficacy of observing well‐appearing patients presenting with fever and nonneutropenia (absolute neutrophil count ≥ 500 cells/mm3). Of 238 episodes, 82.7% patients were observed with no infectious complications and low overall incidence of bacteremia (3.4%). There were no significant differences in individual clinical variables. We propose that observation alone in some well‐appearing febrile pediatric oncology patients is safe and limits the use of unnecessary empiric antibiotics.

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Infectious events in pediatric patients with acute lymphoblastic leukemia/lymphoma undergoing evaluation for fever without severe neutropenia

Patel

DeGroote

Jackson

et al. 2022

Cancer

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Background: Infections cause significant treatment-related morbidity during pediatric acute lymphoblastic leukemia/lymphoma (ALL/LLy) therapy. Fevers during periods without severe neutropenia are common, but etiologies are not welldescribed. This study sought to describe the bloodstream infection (BSI) and non-BSI risk in children undergoing therapy for ALL/LLy. Methods: Demographic and clinical data were abstracted for febrile episodes without severe neutropenia at two children's hospitals. Treatment courses were stratified by intensity. Multivariate logistic regression evaluated characteristics associated with infection. Results: There were 1591 febrile episodes experienced by 524 patients. Of these, 536 (34%) episodes had ≥1 infection; BSI occurred in 30 (1.9%) episodes. No BSIs occurred in episodes with a recent procedural sedation or cytarabine exposure.Presence of hypotension, chills/rigors, higher temperature, and infant phenotype were independently associated with BSI (p < .05). Of the 572 non-BSIs, the most common was upper respiratory infection (URI) (n = 381, 67%). Compared to episodes without infection, URI symptoms, higher temperature, absolute neutrophil count 500−999/μl, and evaluation during a low-intensity treatment course were more likely to be associated with a non-BSI (p < .05) and inpatient status was less likely to be associated with a non-BSI (p < .05). Conclusions:The BSI rate in pediatric patients with ALL/LLy and fever without severe neutropenia is low, but one-third of the time, patients have a non-BSI. Future research should test if the need for empiric antibiotics can be tailored based on the associations identified in this study.

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Bacteremia in nonneutropenic pediatric oncology patients with central venous catheters in the ED

Cited by 20 publications

References 24 publications

Nonneutropenic fever in children with cancer: A scoping review of management and outcome

Nonneutropenic fever in children with cancer: A scoping review of management and outcome

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Infectious events in pediatric patients with acute lymphoblastic leukemia/lymphoma undergoing evaluation for fever without severe neutropenia

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