title: Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever.
abstract: OBJECTIVE
  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.
  
  
  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/mm(3) (RR, 1.7; 95% CI, 1.4 to 2.2); and recent (< or = 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Hospital Luis Calvo Mackenna, Chile. msantola@machi.med.uchile.cl
authors.forename: M E
authors.initials: ME
authors.lastname: Santolaya
authors.forename: A M
authors.initials: AM
authors.lastname: Alvarez
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: J
authors.initials: J
authors.lastname: Cofré
authors.forename: N
authors.initials: N
authors.lastname: Enríquez
authors.forename: M
authors.initials: M
authors.lastname: O'Ryan
authors.forename: E
authors.initials: E
authors.lastname: Payá
authors.forename: J
authors.initials: J
authors.lastname: Pilorget
authors.forename: C
authors.initials: C
authors.lastname: Salgado
authors.forename: J
authors.initials: J
authors.lastname: Tordecilla
authors.forename: M
authors.initials: M
authors.lastname: Varas
authors.forename: M
authors.initials: M
authors.lastname: Villarroel
authors.forename: T
authors.initials: T
authors.lastname: Viviani
authors.forename: M
authors.initials: M
authors.lastname: Zubieta
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000150:complications* / Q000276:immunology / Q000628:therapy; D006801:Humans; D007022:Hypotension / Q000150:complications; D007223:Infant; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D009503:Neutropenia / Q000150:complications* / Q000276:immunology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002097:C-Reactive Protein