The Risk of Serious Bacterial Infection in Neutropenic Immunocompetent Febrile Children

Abstract

Only few reports have looked into the risk of invasive bacterial infection in children with neutropenia that is not malignancy related. The objective of the current study was to determine the clinical significance of neutropenia as a predictor of serious bacterial infection (SBI) in immunocompetent children. We conducted a retrospective case-control study including children 3 months to 18 years of age with fever ≥ 38°C hospitalized or presenting to the emergency department. Patients who had neutropenia ≤ 1000 ANC/μL and had a blood culture taken were matched for age with the consecutive febrile patients for whom a blood culture was taken. The main outcome was the rate of SBI. SBIs were more prevalent among the control group than in the group of children with neutropenia, 19/71 and 6/71, respectively (P = 0.0005). More children were treated with antibiotics among the control group than in the group of children with neutropenia, 39/71 and 20/71, respectively (P < 0.0001). Acute-phase reactants including CRP and platelets were higher in the control group. We concluded that immunocompetent patients with fever and moderate neutropenia do not carry a higher risk for SBIs compared with patients with fever who do not have neutropenia.

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

“…Neutropenia is a decrease in the absolute number of circulating neutrophils, typically defined as ≤1500 cells/ µL. [1][2][3][4][5][6] In children, this may result from a variety of insults, including medication toxicities, congenital processes, viral infections, and overwhelming bacterial sepsis. 2,7 Neutropenia may predispose a patient to an increased risk of infection, particularly with some forms of medically induced immunosuppression (e.g., chemotherapy received by oncology patients).…”

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

“…The risk of infectious complications (ie, developing a secondary SBI) during an episode of transient moderate neutropenia appears to be low;3 9 however, Alario and O'Shea1 found that 4 of the 36 children in their study (of the 191 patients who had neutropenia) who remained neutropenic for more than 30 days developed superficial skin or mucosal infections. None of the children in Alario's study developed invasive infections or bacteraemia.…”

“…Several observational studies have found that there is a low prevalence of SBI (defined by positive blood culture) in children who are febrile with no clinical signs of sepsis, but are incidentally found to be neutropenic 2 3 7…”

“…Moderate neutropenia discovered incidentally during a mild infection does not necessarily prompt hospitalisation;3 it would be prudent, however, to review the blood film at presentation. Even with a reassuring initial blood film, children must be followed up in outpatient clinic with repeat blood tests when well 2 10.…”

Neutropenia in the Febrile Child

“…Limited studies have shown that febrile pediatric patients with transient moderate neutropenia who are otherwise well-appearing do not have increased risk of serious bacterial infection when compared with febrile patients without neutropenia. [12][13][14] However, comparative studies of treatment of these patients is limited, and many centers continue to treat these patients with antibiotics and hospital admission, absent either a known rapid response to G-CSF treatment, or an established history of no serious infections despite neutropenia.…”