The Risk Factor of Bacteremia in Children with Febrile Neutropenia due to Chemotherapy

ABSTRACT

PURPOSE: We evaluated the easily-assessable risk factors to predict bacteremia in children with febrile neutropenia, who received anticancer chemotherapy. METHODS: We retrospectively reviewed 46 children who had febrile neutropenia caused by anticancer chemotherapy between March, 1993 and February, 1997. The patients with localized infection on presentation were not eligible for this study. We evaluated the correlation between bacteremia and some variables, including absolute neutrophil count (ANC), absolute monocyte count (AMoC) and absolute phagocyte count (APC). RESULTS: There was total of 147 consecutive episodes of fever in 46 children, with 90 episodes of fever were noted in neutropenic patients without localized infection. There were 20 episodes of bacteremia (22.2%) in 90 episodes of febrile neutropenia. The mean ANC of 365.5 +/- 448.3/microliter, mean AMoC 132.3 +/- 310.4/microliter and mean APC 502.0 +/- 603.3/microliter did not show significant correlation with bacteremia. There was no statistically significant correlation between bacteremia and ANC or AMoC. There was higher risk of bacteremia in patients with AMoC less than 100/microliter as compared with patients with AMoC above than 100/microliter (odds ratio 1.39, 95%CI 0.41-4.69). There were 17 episodes of bacteremia (28.8% of 59 febrile episodes) in patients with APC less than 500/microliter and 3 episodes of bacteremia (9.7% of 31 febrile episodes) in patients with APC above than 500/microliter (P=0.03, odds ratio 3.78, 95%CI 1.01-14.10). CONCLUSION: There was a statistically-significant correlation between bacteremia and APC with higher risk of bacteremia in patients with APC less than 500/microliter. Trials should be conducted to test whether APC may be used to assign some children to less intensive or outpatient antibiotic therapy at the time of presentation of febrile neutropenia.