Risk of Serious Bacterial Infection in Isolated and Unsuspected Neutropenia

Abstract

Objectives: The objective was to determine the risk of serious bacterial infection (SBI) among children without underlying risk factors for SBI who present to the emergency department (ED) for evaluation and have unsuspected and isolated neutropenia.Methods: This was a retrospective consecutive chart review from October 1995 through September 2003. All patients aged 0-21 years presenting to the ED of an urban tertiary children's hospital, who were documented to have neutropenia (defined as an absolute neutrophil count [ANC] of <1,000 cells ⁄ lL) without known underlying risk factor for SBI were eligible for inclusion. SBI was defined as growth of a pathogen from culture of blood, urine, or cerebrospinal fluid (CSF).Results: There were 3,179 children with an ANC of <1,000 ⁄ lL during the study period. Of these, 1,888 had no underlying immunodeficiency or central venous catheter (CVC). Fifteen of 453 (3.3%; 95% confidence interval [CI] = 1.9% to 5.4%) infants less than 3 months of age had SBI: seven with bacteremia, four with meningitis, and eight with urinary tract infections. SBI was rare among children over 3 months of age (18 of 1,435; 1.3%; 95% CI = 0.7% to 2.0%): one had bacteremia, none had meningitis, and 13 had urinary tract infections.Conclusions: Children older than 3 months of age without underlying immunodeficiency or CVC presenting to the ED and unexpectedly found to have isolated neutropenia are not at high risk of SBI. Infants less than 3 months of age have similar risk of SBI as febrile infants of same age.

The etiologic, microbiologic, clinical and outcome characteristics of immunocompetent young children <2 years of age hospitalized with acute neutropenia

“…In the 10 studies published in the pediatric medical literature during 2005–2020 and dealing with the topic of acute neutropenia diagnosed in immunocompetent children, 2 were prospective, 7 enrolled only febrile patients and the other 3 enrolled both non-febrile and febrile neutropenic patients. 12 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 The number of patients enrolled varied from study to study (range 32–1888) and all included a considerable number of young infants, although the inclusion criteria, in respect to patient age, differed between studies. The percentages of patients with severe neutropenia (ANC < 0.5 cells × 10 9 /L) ranged from 8.5% to 100% (two studies enrolled only patients with severe neutropenia).…”

Rapid diagnosis of infection etiology in febrile pediatric oncology patients using infrared spectroscopy of leukocytes

“…The classical methods currently used in microbiology labs in medical centers to diagnose bacterial infections are based mainly on growing the bacteria in appropriate media for at least 24 h. In the case of viral infections, mainly RT-PCR analysis is used which is relatively expensive [27][28][29][30][31][32]. Immunofluorescence-based assay [33], ELISA [34] and light-emitted diode fluorescence [35] are successfully used for pathogens (viruses/bacteria) detection.…”

Question 2: Unexpected neutropenia in a febrile, but immunocompetent, child

“…Another limitation common to several studies4 5 7 is that blood cultures were not always taken preantibiotics (and sometimes not taken at all), perhaps limiting the value of the blood culture result and masking a true reflection of the incidence of bacteraemia.…”