Safety of discharge for children with cancer and febrile neutropenia off antibiotics using absolute neutrophil count threshold values as a surrogate marker for adequate bone marrow recovery. Issue 3 (8th November 2017)

• Record Type: Journal Article
• Authors: Campbell, Matthew E.; Friedman, Debra L.; Dulek, Daniel E.; Zhao, Zhiguo; Huang, Yi; Esbenshade, Adam J.
• Is Part Of: Pediatric blood & cancer. Volume 65:Issue 3(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-11-08
• Subjects: febrile neutropenia -- health services research -- pediatric oncology -- supportive care; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.26875
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Background: Febrile neutropenia (F&N) is common among pediatric oncology patients. However, there is a lack of clarity regarding parameters whereby such patients have demonstrated adequate bone marrow recovery for hospital discharge and empiric antibiotic discontinuation. Procedure: A retrospective review was performed for 350 episodes of F&N occurring at a single institution between 2007 and 2012 in pediatric oncology patients who were afebrile for 24 hr and had no bacterial source identified. Seven‐day postdischarge outcomes were assessed and compared based on absolute neutrophil count (ANC) at discharge in order to identify an optimal threshold. Results: Overall, 7‐day readmission rates were low (17/350, 4.6%), with patients discharged with post‐nadir ANC of 100–199/μl (2/51, 3.9%), 200–499/μl (5/125, 4.0%), and ≥500/μl (8/160, 5.0%), all having similar rates. Patients with a discharge ANC < 100/μl (2/14, 14.3%) had a higher readmission rate. A new bloodstream infection was identified upon readmission in one patient in each discharge ANC range except for ANC of 100–199/μl, in which none occurred. In a subset of 217 episodes where the ANC fell below 200/μl during the admission and subsequently rose above 100/μl, 94 episodes resulted in 126 additional hospital days while subjects awaited further count recovery. One death occurred in a patient whose ANC at discharge was 290/μl. This patient had received additional chemotherapy after count recovery and prior to discharge, and was readmitted with Clostridium tertium bacteremia. Conclusion: These results suggest that a post‐nadir ANC > 100/μl is a safe threshold value for empiric antibiotic discontinuation and discharge home.