Approach to Non‐Neutropenic Fever in Pediatric Oncology Patients—A Single Institution Study. Issue 12 (14th July 2015)

• Record Type: Journal Article
• Authors: Ali, Bilal Abou; Hirmas, Nader; Tamim, Hani; Merabi, Zeina; Hanna‐Wakim, Rima; Muwakkit, Samar; Abboud, Miguel; Solh, Hassan El; Saab, Raya
• Is Part Of: Pediatric blood & cancer. Volume 62:Issue 12(2015:Dec.)
• Page Start: 2167
• Page End: 2171
• Publication Date: 2015-07-14
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.25660
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pbc25660-sec-0001" sec-type="section"> <title>Background</title> <p>Pediatric oncology patients with fever, even when not neutropenic, are known to be at an increased risk of bloodstream infections. However, there are no standard guidelines for management of fever in non‐neutropenic patients, resulting in variability in practice across institutions.</p> </sec> <sec id="pbc25660-sec-0002" sec-type="section"> <title>Procedure</title> <p>We retrospectively analyzed the clinical characteristics, management, and outcome of all febrile non‐neutropenic episodes in pediatric oncology patients at a single institution over the two‐year period 2011–2012, to identify predictors of bloodstream infections. We assessed the efficacy of a uniform approach to outpatient management of a defined subset of patients at low risk of invasive infections.</p> </sec> <sec id="pbc25660-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 254 episodes in 83 patients were identified. All patients had implanted central venous catheters (port). Sixty‐two episodes (24%) were triaged as high‐risk and admitted for inpatient management; five (8%) had positive blood cultures. The remaining 192 episodes were triaged as low risk and managed with once daily outpatient intravenous ceftriaxone; three (1.6%) were associated with bacteremia, and 10% required eventual inpatient management. Of all the factors analyzed, only signs of sepsis (lethargy, chills, hypotension) were associated with positive bloodstream infection.</p> </sec> <sec id="pbc25660-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Treatment of a defined subset of patients with outpatient intravenous ceftriaxone was safe and effective. Signs of sepsis were the only factor significantly associated with bloodstream infection. This study provides a baseline for future prospective studies assessing the safety of withholding antibiotics in this subset of patients. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.</p> </sec> </abstract>