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Prospective, Multicenter Evaluation of Risk Factors Associated With Invasive Bacterial Infection in Children With Cancer, Neutropenia, and Fever

From the Department of Pediatrics, Hospital Luis Calvo Mackenna; Department of Pediatrics, Hospital San Juan de Dios; Department of Pediatrics, Hospital Sótero del Río; Department of Pediatrics, Hospital Roberto del Río; Microbiology Program, Faculty of Medicine, Universidad de Chile; Department of Pediatrics, Hospital Exequiel González Cortés; and Subcommittee of Infectious Diseases of the National Child Program of Antineoplastic Drugs, Santiago, Chile.

Address reprint requests to María Elena Santolaya, MD, Los Huasos 1948, Las Condes, Santiago, Chile; email: msantola{at}machi.med .uchile.cl.

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.

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