Bacteremia in Febrile, Non-neutropenic, and Well-appearing Children With Cancer

• Published in: Journal of pediatric hematology/oncology
• Main Authors: Beauchemin, Melissa, Marshall, Alison F., Ricci, Angela M., Lopez, Ibis D., Yao, Yujing, Lee, Alice, Jin, Zhezhen, Sulis, Maria L.
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer Health, Inc. All rights reserved 18-05-2021
• ISSN: 1077-4114
• DOI: 10.1097/MPH.0000000000002201

Fever in a neutropenic pediatric oncology patient requires prompt assessment due to the risk of infectious complications. The appropriate management of fever in non-neutropenic patients, however, is not well-established. We describe the rate of bacteremia in a cohort of non-neutropenic pediatric oncology patients with fever at a large institution. Patients were included if they presented to the emergency department or outpatient clinic between 2009 and 2014 with fever, had a central venous catheter (CVC), and were not neutropenic. Three hundred eighty-six episodes of fever occurring in 159 patients were included in the data analysis. Fifty-nine percent of patients were male, 41% had a diagnosis of acute lymphoblastic leukemia, and 90% had a port-a-cath as CVC. The rate of bacteremia was 3.4%; presence of a port-a-cath was protective against bacteremia whereas a white blood cell count >20,000/mm3 was associated with a higher likelihood of bacteremia. Gram-positive microorganisms were most commonly isolated (64.3%) and frequently resistant to cephalosporins. In summary, in our study, the rate of bacteremia was low among non-neutropenic, well-appearing pediatric cancer patients with a CVC and was not associated with any serious medical complications. Prospective research is needed to determine the most appropriate management of these patients.