Evaluation of Febrile, Nonneutropenic Pediatric Oncology Patients with Central Venous Catheters Who Are Not Given Empiric Antibiotics

Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia

“…For those previously published, local investigators used additional medical record review to document all inclusion criteria and delete cases meeting exclusion criteria. Bartholomew et al published a dataset of 392 episodes of pediatric non-neutropenic fever 3 . After applying EsVan inclusion and exclusion criteria, this resulted in a cohort of 348 episodes of which 312 episodes with complete data were used for the primary analysis with the additional episodes to be included in sensitivity analysis.…”

Approach to Non-Neutropenic Fever in Pediatric Oncology Patients-A Single Institution Study

“…The low number of bacteremic episodes in our patients limits comparisons with rates of bacteremia found in other reports. One recent study suggested that for non‐neutropenic patients, it may be safe to withhold antibiotics and treat only those with signs of sepsis or chills . On the other hand, another recent single‐institution study reported that almost 50% of bacteremic episodes in non‐neutropenic febrile patients were due to gram‐negative organisms .…”

“…In all studies, however, the incidence of bacteremia in non‐neutropenia cancer patients with fever was not negligible. More recently, a few studies have suggested that it may be safe to observe a subset of patients with non‐neutropenic fever and no evidence of sepsis or chills, without administration of antibiotics . Although Gorelick et al suggested, based on the high incidence of bacteremia in their studied cohort, that empiric antibiotic therapy is warranted in all pediatric oncology patients with indwelling catheters who develop fever, Minotti et al found that single‐agent oral antibacterial therapy may be as effective and safe as broad‐spectrum parenteral therapy in low‐risk neutropenic and non‐neutropenic cancer patients.…”

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

“…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 .…”

“…antibiotics is safe in patients with FNN; however, this practice still exposes patients to broad‐spectrum antibiotics, often repeatedly, with unclear effects on their endogenous microbiomes. More recently, a retrospective study supported observation of patients with FNN . This practice would offer many potential benefits, including reducing hospitalizations, antibiotic exposure, and overall antibiotic resistance.…”