Prospective, Multicenter Evaluation of Risk Factors Associated With Invasive Bacterial Infection in Children With Cancer, Neutropenia, and Fever
- 15 July 2001
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 19 (14), 3415-3421
- https://doi.org/10.1200/jco.2001.19.14.3415
Abstract
PURPOSE: To identify clinical and laboratory parameters present at the time of a first evaluation that could help predict which children with cancer, fever, and neutropenia were at high risk or low risk for an invasive bacterial infection. PATIENTS AND METHODS: Over a 17-month period, all children with cancer, fever, and neutropenia admitted to five hospitals in Santiago, Chile, were enrolled onto a prospective protocol. Associations between admission parameters and risk for invasive bacterial infection were assessed by univariate and logistic regression analyses. RESULTS: A total of 447 febrile neutropenic episodes occurred in 257 children. Five parameters were statistically independent risk factors for an invasive bacterial infection. Ranked by order of significance, they were as follows: C-reactive protein levels of 90 mg/L or higher (relative risk [RR], 4.2; 95% confidence interval [CI], 3.6 to 4.8); presence of hypotension (RR, 2.7; 95% CI, 2.3 to 3.2); relapse of leukemia as cancer type (RR, 1.8, 95% CI, 1.7 to 2.3); platelet count less than or equal to 50,000/mm3 (RR, 1.7; 95% CI, 1.4 to 2.2); and recent (≤ 7 days) chemotherapy (RR, 1.3; 95% CI, 1.1 to 1.6). Other previously postulated risk factors (magnitude of fever, monocyte count) were not independent risk factors in this study population. CONCLUSION: In a large population of children, common clinical and laboratory admission parameters were identified that can help predict the risk for an invasive bacterial infection. These results encourage the possibility of a more selective management strategy for these children.Keywords
This publication has 23 references indexed in Scilit:
- Oral versus Intravenous Empirical Antimicrobial Therapy for Fever in Patients with Granulocytopenia Who Are Receiving Cancer ChemotherapyNew England Journal of Medicine, 1999
- A Double-Blind Comparison of Empirical Oral and Intravenous Antibiotic Therapy for Low-Risk Febrile Patients with Neutropenia during Cancer ChemotherapyNew England Journal of Medicine, 1999
- Outpatient treatment with ceftriaxone alone or incombination with teicoplanin in febrile neutropenic children and adolescentswith cancerThe Journal of Pediatrics, 1997
- Outpatient treatment of febrile neutropenic patients with cancerEuropean Journal Of Cancer, 1995
- Cessation of Antibiotics Regardless of ANC Is Safe in Children with Febrile NeutropeniaJournal of Pediatric Hematology/Oncology, 1995
- Is it time to redefine the management of febrile neutropenia in cancer patients?American Journal Of Medicine, 1995
- Febrile neutropeniaCurrent Opinion in Oncology, 1993
- Randomised comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febrile patientsThe Lancet, 1992
- The child with cancer and infection. I. Empiric therapy for fever and neutropenia, and preventive strategiesThe Journal of Pediatrics, 1991
- Fever in the Pediatric and Young Adult Patient with CancerMedicine, 1982