Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia

Haeusler, Gabrielle M; Lourenço, Richard De Abreu; Clark, Howard; Thursky, Karin; Slavin, Monica A; Babl, Franz E; Méchinaud, Françoise; Alvaro, Frank; Clark, Julia; Padhye, Bhavna; Phillips, Marianne; Super, Leanne; Tapp, Heather; Walwyn, Thomas; Ziegler, David S.; Phillips, Bob; Worth, Leon J

doi:10.1093/jpids/piaa029

Cited by 13 publications

(26 citation statements)

References 15 publications

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“…While early studies found up to 22% of children with FN had a bacteraemia, more recent observational data indicate that bacteraemia rates may be lower than this and likely explained by the exclusion of common commensals unless cultured more than once. 3 Not surprisingly, the diagnostic yield is highest when two or more blood cultures are taken prior to the first dose of antibiotics and, in the absence of a new fever or clinical instability, blood cultures beyond 48 hours of persistent fever have limited diagnostic utility. 3 stream infections in patients with a central venous catheter (CVC) are detected in cultures taken from a peripheral vein only, suggesting both CVC and peripheral vein cultures should be collected to optimise diagnosis.…”

Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 99%

“…3 Not surprisingly, the diagnostic yield is highest when two or more blood cultures are taken prior to the first dose of antibiotics and, in the absence of a new fever or clinical instability, blood cultures beyond 48 hours of persistent fever have limited diagnostic utility. 3 stream infections in patients with a central venous catheter (CVC) are detected in cultures taken from a peripheral vein only, suggesting both CVC and peripheral vein cultures should be collected to optimise diagnosis. 18 The quality of collection, including number of sets (aerobic and anaerobic) taken pre antibiotics and volume of blood have also been shown to impact the diagnostic yield of blood cultures in the general paediatric population, highlighting the importance of specific blood culture collection guidelines in FN.…”

Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 99%

“…1 Overall gram positive organisms tend to be identified in blood cultures slightly more commonly than gram negative organisms, however this ratio is influenced by the timing of blood cultures (i.e pre or post antibiotic), presence of central lines and concurrent antibacterial prophylaxis. 2,3 In a large series of FN episodes in children with cancer, 59% of children had no documented clinical or microbiological evidence of infection, 24% had bacteraemia, 2% had a microbiologically documented infection without bacteraemia, 6% had a clinically documented infection and 9% had a fungal infection. 4 Owing to the risk of bacteraemia, FN is traditionally managed by urgent hospital attendance and empirical broad spectrum intravenous antibiotics until resolution of fever with average inpatient stay reported as 5 days across many UK and Australian paediatric oncology settings.…”

Section: Introductionmentioning

confidence: 99%

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Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Morgan¹,

Phillips²,

Haeusler³

et al. 2021

IDR

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Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating deescalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.

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Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 99%

Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Morgan¹,

Phillips²,

Haeusler³

et al. 2021

IDR

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“…Total analysis time at risk was 24,713 days and incidence rate of unfavourable outcome was 0.22 per 100 person-days (95% CI 0.17–0.29). Bloodstream infections associated with these FN episodes are reported in detail elsewhere [ 13 ], but there were 58/858 (6.8%) episodes of FN attributed to gram-negative bloodstream infection in total, with E . coli , Klebsiella species, and Pseudomonas species as the most common gram-negative species identified, in 19 (2.2%), 14 (1.6%) and 12 (1.4%) of episodes, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…All sites recommended 48h maximum empiric use of aminoglycosides, with treatment of confirmed infection at the discretion of the treating physician. Bloodstream infections associated with these FN episodes are reported in detail elsewhere [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Aminoglycoside use in paediatric febrile neutropenia – Outcomes from a nationwide prospective cohort study

et al. 2020

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Aminoglycosides are commonly prescribed to children with febrile neutropenia (FN) but their impact on clinical outcomes is uncertain and extent of guideline compliance is unknown. We aimed to review aminoglycoside prescription and additional antibiotic prescribing, guideline compliance and outcomes for children with FN. We analysed data from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) prospective multicentre cohort study, in children <18 years with FN between November 2016 and January 2018. Impact of aminoglycoside use in the first 12 hours of FN on composite unfavourable outcome of death, ICU admission, relapse of infection or late-onset sepsis was assessed using multivariable Cox regression. The study was conducted in Australia where antimicrobial resistance among gram negative organisms is relatively low. Data from 858 episodes of FN in 462 children from 8 centres were assessed, median age 5.8 years (IQR 3.5–10.8 years). Early empiric aminoglycosides were prescribed in 255 episodes (29.7%). Guideline non-compliance was common: in 46% (184/400) of eligible episodes, patients did not receive aminoglycosides, while aminoglycosides were prescribed in 9% (39/458) of guideline-ineligible episodes. Adjusted hazard of the composite unfavourable outcome was 3.81 times higher among patients prescribed empiric aminoglycosides than among those who weren’t (95% confidence interval, 1.89–7.67), with no increased risk of unfavourable outcome in eligible patients who did not receive aminoglycosides. In a large paediatric FN cohort, aminoglycoside prescription was common and was often non-compliant with guidelines. There was no evidence for improved outcome with aminoglycosides, even in those who met guideline criteria, within a low-resistance setting. Empiric aminoglycoside prescription for children with FN requires urgent review in guidelines and in national practice.

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Diagnostic yield of bronchoscopy in children with leukemia or post hematopoietic stem cell transplant

Georgescu,

Rahrig,

Montgomery

et al. 2023

Pediatric Pulmonology

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BackgroundThe utility of bronchoscopy with bronchoalveolar lavage (BAL) in immunocompromised children is not well understood. We aim to describe the bronchoscopy diagnostic yield and complications and to investigate factors associated with diagnostic yield.MethodsThis is a single‐center, retrospective cohort study of 60 children with leukemia or post‐hematopoietic stem cell transplant who had a bronchoscopy with BAL between 2017 and 2021. Comparisons were done with regression analysis.ResultsOf the 60 bronchoscopies performed, 46 (77%) revealed diagnostic information: 39 (65%) identified a pathogen, 14 (23.3%) found secretions/mucus plugging, and 6 (10%) found pulmonary hemorrhage. BAL results changed antimicrobial therapy in 27 (45%) cases. Bronchoscopies were performed in the intensive care unit (27/60) or operating room (33/60), with the former having a higher diagnostic yield (96% vs. 60%, p = 0.001). Half (50%) of bronchoscopies found a new infectious diagnosis. Respiratory symptoms (n = 58, 97%), supplemental oxygen use (n = 39, 65%), and antibiotic use (n = 56, 93%) before bronchoscopy were all common. The median volume of fluid instilled during bronchoscopy was 1.3 mL/kg (interquatile range [IQR]: 0.7, 2.6). None of these factors were associated with the diagnostic yield. Complications were rare and minor with only one child having self‐resolved bleeding and four children, previously in room air requiring a nasal cannula. For the 27 (45%) children on mechanical ventilation when the bronchoscopy was performed, there was no difference in ventilator settings pre‐ and post‐bronchoscopy.ConclusionBronchoscopies with BAL are useful, safe, and important in the diagnostic management of pulmonary complications in this cohort of children.

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Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia

Cited by 13 publications

References 15 publications

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Aminoglycoside use in paediatric febrile neutropenia – Outcomes from a nationwide prospective cohort study

Diagnostic yield of bronchoscopy in children with leukemia or post hematopoietic stem cell transplant

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