Blood Cultures for Persistent Fever in Neutropenic Pediatric Patients Are of Low Diagnostic Yield

Abstract

The incidence of bacteremia at the onset of pediatric febrile neutropenia (FN) at 2 academically linked institutions was 9.84%, and subsequent blood cultures performed for children with persistent FN yielded an incidence of 4.21%. Until the risk factors for new-onset bacteremia in patients being treated for FN can be identified and diagnostic methods can be improved, compliance with national guidelines is recommended.

Repeated Blood Cultures in Pediatric Febrile Neutropenia: Would Following the Guidelines Alter the Outcome?

“…Studies evaluating the utility of subsequent blood cultures in the setting of an initially negative culture have found an initial prevalence of bacteremia of 9.8–18.4%, and a 0.9–10.9% prevalence of subsequent blood culture positivity . A study of adult and pediatric hematopoietic stem cell transplant (HSCT) patients found one new positive blood culture in 109 patients after day 1 (0.9%) in a retrospective review .…”

“…Another retrospective review of pediatric solid oncology patients found that in 220 FN episodes in 105 patients, 24 (10.9%) new positive cultures were found positive after day 1, but neither specific timing nor determination of pathogen versus contaminant was reported . Another retrospective chart review of pediatric solid tumor patients found two pathogens after day 1 in 193 FN episodes, without comment on change in clinical status . A study examining risk factors of subsequent blood culture positivity in HSCT pediatric patients found a 1.5% incidence of new blood stream infection (BSI) per day, with risk factors including previous BSI within 30 days and increased length of time between fevers .…”

“…[6] Studies evaluating the utility of subsequent blood cultures in the setting of an initially negative culture have found an initial prevalence of bacteremia of 9.8-18.4%, and a 0.9-10.9% prevalence of subsequent blood culture positivity. [7][8][9][10] A study of adult and pediatric hematopoietic stem cell transplant (HSCT) patients found one new positive blood culture in 109 patients after day 1 (0.9%) in a retrospective review. [7] Another retrospective review of pediatric solid oncology patients found that in 220 FN episodes in 105 patients, 24 (10.9%) new positive cultures were found positive after day 1, but neither specific timing nor determination of pathogen versus contaminant was reported.…”

“…[8] Another retrospective chart review of pediatric solid tumor patients found two pathogens after day 1 in 193 FN episodes, without comment on change in clinical status. [10] A study examining risk factors of subsequent blood culture positivity in HSCT pediatric patients found a 1.5% incidence of new blood stream infection (BSI) per day, with risk factors including previous BSI within 30 days and increased length of time between fevers. [9] In summary, previous reviews on this topic included variable malignancy populations and lacked details on clinical status, pathogen versus contaminant, and day of blood culture positivity within FN episode, thus making it difficult to apply conclusions to a broad population.…”

Factors predicting the identification of new organisms in follow‐up blood cultures drawn during episodes of neutropenic sepsis

“…While patients presenting with neutropenic fever have high rates of initial bacteraemia (Freifeld et al , ), follow‐up blood cultures appear to have a very low yield (Serody et al , ; Wattier et al , ; Neemann et al , ). As previous studies have examined only small numbers of patients, we used a data linkage approach to assess the frequency and predictors of new isolates in follow‐up blood cultures during episodes of suspected neutropenic sepsis.…”