Bacteremia in Febrile Nonneutropenic Pediatric Oncology Patients

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/mu l 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. Pediatr Blood Cancer 2010;54:83-87. (C) 2009 Wiley-Liss, Inc.