Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia
- 8 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of the Pediatric Infectious Diseases Society
- Vol. 10 (2), 125-130
- https://doi.org/10.1093/jpids/piaa029
Abstract
Background: The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. Methods: Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. Results: A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. Conclusions: In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.Keywords
Funding Information
- National Health and Medical Research Council (APP1104527)
- Victorian Cancer Agency (ECHSRF18024)
This publication has 15 references indexed in Scilit:
- Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rulesEClinicalMedicine, 2020
- Evidence-Based Guidelines to Eliminate Repetitive Laboratory TestingJAMA Internal Medicine, 2017
- Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 UpdateJournal of Clinical Oncology, 2017
- Repeated Blood Cultures in Pediatric Febrile Neutropenia: Would Following the Guidelines Alter the Outcome?Pediatric Blood & Cancer, 2016
- Repeat blood cultures in children with persistent fever and neutropenia: Diagnostic and clinical implicationsPediatric Blood & Cancer, 2015
- Blood Cultures for Persistent Fever in Neutropenic Pediatric Patients Are of Low Diagnostic YieldJournal of the Pediatric Infectious Diseases Society, 2015
- Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negativePediatric Blood & Cancer, 2012
- Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2011
- Utility of obtaining blood cultures in febrile neutropenic patients undergoing bone marrow transplantationBone Marrow Transplantation, 2000
- A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studiesBritish Journal of Haematology, 1997