Soner Sertan KARA, Neşe YARALI, Zühre KAYA, Saliha KANIK YÜKSEK, Ülker KOÇAK, Tuğba Bedir DEMİRDAĞ, Anıl TAPISIZ, Ali FETTAH, Namık ÖZBEK, Meltem POLAT, İdil YENİCESU, Burcu Ceylan CURA YAYLA, Arzu OKUR, Hasan TEZER

Risk factors for bacteremia in children with febrile neutropenia

Background/aim: Bacteremia remains an important cause of morbidity and mortality during febrile neutropenia (FN) episodes. Weaimed to define the risk factors for bacteremia in febrile neutropenic children with hemato-oncological malignancies.Materials and methods: The records of 150 patients aged ≤18 years who developed FN in hematology and oncology clinics wereretrospectively evaluated. Patients with bacteremia were compared to patients with negative blood cultures.Results: The mean age of the patients was 7.5 ± 4.8 years. Leukemia was more prevalent than solid tumors (61.3% vs. 38.7%). Bacteremiawas present in 23.3% of the patients. Coagulase-negative staphylococci were the most frequently isolated microorganism. Leukopenia,severe neutropenia, positive peripheral blood and central line cultures during the previous 3 months, presence of a central line, previousFN episode(s), hypotension, tachycardia, and tachypnea were found to be risk factors for bacteremia. Positive central line culturesduring the previous 3 months and presence of previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold,respectively.Conclusion: Presence of a bacterial growth in central line cultures during the previous 3 months and presence of any previous FNepisode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. These factors can predict bacteremia in childrenwith FN.

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1. Castagnola E, Fontana V, Caviglia I, Caruso S, Faraci M et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clinical Infectious Diseases 2007; 45: 1296-1304.
2. Akova M, Alp S. Management of febrile neutropenia in the era of bacterial resistance. Therapeutic Advances in Infectious Diseases 2013; 1: 37-43.
3. Santolaya ME, Farfán MJ, De La Maza V, Cociña M, Santelices F et al. Diagnosis of bacteremia in febrile neutropenic episodes in children with cancer. Pediatric Infectious Diseases Journal 2011; 30: 957-961.
4. Wildi K, Tschudin-Sutter S, Dell-Kuster S, Frei R, Bucher HC et al. Factors associated with positive blood cultures in outpatients with suspected bacteremia. European Journal of Clinical Microbiology & Infectious Diseases 2011; 30: 1615- 1619.
5. Stabell N, Nordal E, Stensvold E, Gammelsrud KW, Lund B et al. Febrile neutropenia in children with cancer: a retrospective Norwegian multicentre study of clinical and microbiological outcome. Scandinavian Journal of Infectious Diseases 2008; 40: 301-307.
6. Lücking V, Rosthøj S. Prediction of bacteremia in children with febrile episodes during chemotherapy for acute lymphoblastic leukemia. Pediatric Hematology and Oncology 2013; 30: 131- 140.
7. Orudjev E, Lange BJ. Evolving concepts of management of febrile neutropenia in children with cancer. Medical and Pediatric Oncology 2002; 39: 77-85.
8. Ha YE, Song JH, Kang WK, Peck KR, Chung DR et al. Clinical factors predicting bacteremia in low-risk febrile neutropenia after anti-cancer chemotherapy. Supportive Care in Cancer. 2011; 19: 1761-1767.
9. Lucas KG, Brown AE, Armstrong D, Chapman D, Heller G. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer 1996; 77: 791-798.
10. Rondinelli PI, Ribeiro Kde C, de Camargo B. A proposed score for predicting severe infection complications in children with chemotherapy-induced febrile neutropenia. Journal of Pediatric Hematology and Oncology 2006; 28: 665-670.
11. Santolaya ME, Alvarez AM, Becker A, Cofre J, Enriquez N et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. Journal of Clinical Oncology 2001; 19: 3415-3421.
12. Mian A, Becton D, Saylors R, James L, Tang X et al. Biomarkers for risk stratification of febrile neutropenia among children with malignancy: a pilot study. Pediatric Blood & Cancer 2012; 59: 238-245.
13. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2011; 52: e56-e93.
14. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008; 36: 309-332.
15. Feld R. Bloodstream infections in cancer patients with febrile neutropenia. International Journal of Antimicrobial Agents 2008; 32: S30-S33.
16. Bagnasco F, Haupt R, Fontana V, Valsecchi MG, Rebora P et al. Risk of repeated febrile episodes during chemotherapy-induced granulocytopenia in children with cancer: a prospective single center study. Journal of Chemotherapy 2012; 24: 155-160.
17. Ammann RA, Bodmer N, Hirt A, Niggli FK, Nadal D et al. Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study. Journal of Clinical Oncology 2010; 28: 2008-2014.
18. Paesmans M, Klastersky J, Maertens J, Georgala A, Muanza F et al. Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter? Support Care in Cancer 2011; 19: 1001-1008.
19. Bothra M, Seth R, Kapil A, Dwivedi SN, Bhatnagar S et al. Evaluation of predictors of adverse outcome in febrile neutropenic episodes in pediatric oncology patients. Indian Journal of Pediatrics 2013; 80: 297-302.
20. Prasad M, Chinnaswamy G, Arora B, Vora T, Hawaldar R et al. Risk predictors for adverse outcome in pediatric febrile neutropenia: Single center experience from a low and middle-income country. Indian Journal of Cancer 2014; 51: 432-437.
21. Celebi S, Sezgin ME, Cakır D, Baytan B, Demirkaya M et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatric Hematology and Oncology 2013; 30: 187-194.
22. Giacobbe DR, Del Bono V, Bruzzi P, Corcione S, Giannella M et al. Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study. European Journal of Clinical Microbiology & Infectious Diseases 2017; 36: 663-669.
23. Al Omar S, Nazer L, Alkayed K. A prospective study of febrile neutropenia in pediatric cancer patients in Jordan. Journal of Pediatric Hematology and Oncology 2013; 35: 614-617.
24. Rosa RG, Goldani LZ, dos Santos RP. Risk factors for multidrug-resistant bacteremia in hospitalized cancer patients with febrile neutropenia: a cohort study. American Journal of Infection Control 2014; 42: 74-76.
25. Penack O, Becker C, Buchheidt D, Christopeit M, Kiehl M et al. Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO). Annals of Hematology 2014; 93: 1083-1095.
26. Bate J, Gibson F, Johnson E, Selwood K Skinner R et al. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients (NICE Clinical Guideline CG151). Archives of Diseases in Childhood – Education and Practice 2013; 98: 73-75.
27. Asturias EJ, Corral JE, Quezada J. Evaluation of six risk factors for the development of bacteremia in children with cancer and febrile neutropenia. Current Oncology 2010; 17: 59-63.
28. Ariffin H, Navaratnam P, Lin HP. Surveillance study of bacteraemic episodes in febrile neutropenic children. International Journal Clinical Practice 2002; 56: 237-240.
29. Hakim H, Flynn PM, Srivastava DK, Knapp KM, Li C et al. Risk prediction in pediatric cancer patients with fever and neutropenia. Pediatric Infectious Diseases Journal 2010; 29: 53-59.
30. Menichetti F. Infectious complications in neutropenic cancer patients. Internal and Emergency Medicine 2010; 5 (Suppl. 1): S21-S25.
31. Delebarre M, Garnier N, Macher E, Thebaud E, Mazingue F et al. Which variables are useful for predicting severe infection in children with febrile neutropenia? Journal of Pediatric Hematology and Oncology 2015; 37: e468-e474.
32. Cunha BA. Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin resistant Staphylococcus aureus. Medical Clinics of North America 2006; 90: 1165-1182.
33. Depasse J, Caniza MA, Quessar A, Khattab M, Hessissen L et al. Infections in hospitalized children and young adults with acute leukemia in Morocco. Pediatric Blood & Cancer 2013; 60: 916-922.
34. Solís Y, Álvarez AM, Fuentes D, de la Barra D, Avilés CL et al. Bloodstream infections in children with cancer and high risk fever and neutropenia episodes in six hospitals of Santiago, Chile between 2004 and 2009. Revista Chilena de Infectologia 2012; 29: 156-162.
35. Santolaya ME, Alvarez A, Aviles CL, Becker A, King A et al. Predictors of severe sepsis not clinically apparent during the first twenty-four hours of hospitalization in children with cancer, neutropenia and fever. Pediatric Infectious Diseases Journal 2008; 27: 538-543.
36. Santolaya ME, Alvarez AM, Aviles CL, Becker A, Mosso C et al. Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode. Pediatric Infectious Diseases Journal 2007; 26: 794- 798.
37. Hakim H, Flynn P, Knapp K, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. Journal of Pediatric Hematology and Oncology 2009; 31: 623-629.