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

Abstract

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.

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

“…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.…”

“…Seven different definitions of fever were used, with the most common being a single temperature greater than or equal to 38°C (4 studies) . Conversely, only three different definitions of nonneutropenia were used, with the most common being an ANC equal to or greater than 500 cells/μL (13 studies) . A definition of bacteremia was reported in eight studies, with only four studies requiring common commensals to be cultured more than once …”

“…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%) .…”

“…In two studies, antibiotics were only administered to patients with rigors or unwell appearance, resulting in a subset of patients on no antibiotics for the NNF episode . Notably, only 7 of 24 episodes of NNF with bacteremia that were not commenced on antibiotics required readmission in one study, and there were no admissions to the intensive care unit or deaths with this approach across both …”

“…Results of a data linkage study from the United States suggest similarly high rates of NNF presentations to the emergency department . This burden of NNF has been previously http://unrecognized, as evidenced by the paucity of guidelines, care pathways, and dedicated research in this area . Furthermore, little is known about the cause of fever, frequency of bacteremia, and outcomes of these patients.…”