title: Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever.
abstract: BACKGROUND
  The objective of this study was to determine whether vomiting at presentation of a febrile illness in immunocompromised children with central venous catheters (CVCs) predicts bacteremia.
  
  
  METHODS
  A chart review was conducted of children who were admitted to the hospital with a diagnosis of cancer or aplastic anemia, fever, and a CVC. Data were collected on the presence or absence of vomiting, catheter type, presence or absence of severe neutropenia, C-reactive protein (Crp) value, and culture results.
  
  
  RESULTS
  There were 143 admissions for fever among 48 children. Among 35 admissions with emesis, 19 included bacteremia; whereas, among 107 admissions without emesis, 19 included bacteremia (P < .001). There was a 5-fold greater risk of bacteremia in children with children without vomiting (odds ratio, 5.50; 95% confidence interval, 2.20-13.67). Gram-negative organisms were more likely to be associated with vomiting than Gram-positive organisms (P = .008). Children with severe neutropenia did not have a significantly higher rate of bacteremia than children who had neutrophil counts >500 cells/mm(3). Other factors that were associated with higher rates of bacteremia were underlying diagnosis and catheter type.
  
  
  CONCLUSIONS
  Immunocompromised children with a CVC and a fever who presented with vomiting were more likely to have bacteremia than similar children who presented without vomiting. Gram-negative organisms were more likely to be associated with emesis than Gram-positive organisms. The absence of severe neutropenia was not associated with a decreased likelihood of bacteremia. These findings may be useful in identifying children who are at high risk for bacteremia and in determining initial, empiric therapy.
authors.affiliation: Baystate Children's Hospital, Springfield, MA, USA. matthew.richardson@bhs.org
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Richardson
authors.forename: Satkiran S
authors.initials: SS
authors.lastname: Grewal
authors.forename: Paul F
authors.initials: PF
authors.lastname: Visintainer
mesh_terms: D000741:Anemia, Aplastic / Q000150:complications; D016470:Bacteremia / Q000175:diagnosis*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D004866:Equipment Contamination; D005260:Female; D005334:Fever / Q000209:etiology*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D014839:Vomiting / Q000175:diagnosis*