Bacteremia in febrile nonneutropenic pediatric oncology patients.

Abstract:

BACKGROUND:We sought to determine the risk of bacteremia in a cohort of outpatient febrile nonneutropenic pediatric oncology patients and to assess clinical characteristics that may influence decisions regarding empiric antibiotic therapy. PROCEDURE:A single institution retrospective cohort study was performed of outpatient pediatric oncology patients presenting with fever, a central venous catheter, and an absolute neutrophil count (ANC) of >/=500/microl over a 6-year period. We also collected data regarding the presence of clinically evident infections, antibiotics prescribed, and the sensitivity of bacteria to specific antibiotics. RESULTS:There were 29 cases of bacteremia in 459 (6.3%) febrile outpatient visits by 167 patients. Bacteremia was documented in 4.4% of patients with ports and in 16.2% of patients with external catheters. Patients with external catheters had a relative risk of bacteremia of 3.7 (95% CI: 1.8-7.4) times the risk of those with internal catheters (P < 0.0001). A documented source for fever on exam was noted in 21% of patients but in none of the patients with bacteremia (P = 0.004). Empiric treatment with ceftriaxone was administered to 92% of the patients. Of the high-risk bacteremic infections (Gram-negative organisms, Streptococcus pneumoniae, viridans group streptococcus, and Staphylococcus aureus) 94% had at least an intermediate sensitivity to ceftriaxone. CONCLUSIONS:Bacteremia is an important issue in febrile nonneutropenic pediatric oncology patients occurring in 6% of the patient visits in this study. The overall sensitivity of high-risk bacteremia to ceftriaxone provides justification for its empiric use in outpatient febrile nonneutropenic pediatric oncology patients.

journal_name

Pediatr Blood Cancer

journal_title

Pediatric blood & cancer

authors

Kelly MJ,Vivier PM,Panken TM,Schwartz CL

doi

10.1002/pbc.22264

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

83-7

issue

1

eissn

1545-5009

issn

1545-5017

journal_volume

54

pub_type

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