Gabrielle M Haeusler1,2,3,4,5,6, Richard De Abreu Lourenco7, Hannah Clark4, Karin A Thursky1,2,3,8,9,10, Monica A Slavin1,2,3,8,10, Franz E Babl6,11,12, Francoise Mechinaud13, Frank Alvaro14, Julia Clark15, Bhavna Padhye16, Marianne Phillips17, Leanne Super18, Heather Tapp19, Thomas Walwyn17, David Ziegler20, Robert Phillips21, Leon J Worth1,2,3. 1. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia. 2. National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. 3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. 4. Paediatric Integrated Cancer Service, Victoria State Government, Melbourne, Australia. 5. Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Australia. 6. Murdoch Children's Research Institute, Melbourne, Australia. 7. Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia. 8. Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. 9. NHMRC, National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia. 10. Victorian Infectious Diseases Service, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia. 11. Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Australia. 12. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia. 13. Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France. 14. Children's Cancer Department, John Hunter Children's Hospital, University of Newcastle, Newcastle, Australia. 15. Infection Management Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia. 16. Kid's Cancer Centre, Westmead Children's Hospital, Sydney, Australia. 17. Department of Oncology, Perth Children's Hospital, Perth, Australia. 18. Children's Cancer Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia. 19. Department of Oncology, Women's and Children's Hospital, Adelaide, Australia. 20. Kid's Cancer Centre, Sydney Children's Hospital, Sydney, Australia. 21. Centre for Reviews and Dissemination, University of York, York, United Kingdom.
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.
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.
Authors: Brendan J McMullan; Gabrielle M Haeusler; Lisa Hall; Louise Cooley; Andrew J Stewardson; Christopher C Blyth; Cheryl A Jones; Pamela Konecny; Franz E Babl; Françoise Mechinaud; Karin Thursky Journal: PLoS One Date: 2020-09-16 Impact factor: 3.240