title: Approach to Non-Neutropenic Fever in Pediatric Oncology Patients-A Single Institution Study.
abstract: BACKGROUND
  Pediatric oncology patients with fever, even when not neutropenic, are known to be at an increased risk of bloodstream infections. However, there are no standard guidelines for management of fever in non-neutropenic patients, resulting in variability in practice across institutions.
  
  
  METHODS
  We retrospectively analyzed the clinical characteristics, management, and outcome of all febrile non-neutropenic episodes in pediatric oncology patients at a single institution over the two-year period 2011-2012, to identify predictors of bloodstream infections. We assessed the efficacy of a uniform approach to outpatient management of a defined subset of patients at low risk of invasive infections.
  
  
  RESULTS
  A total of 254 episodes in 83 patients were identified. All patients had implanted central venous catheters (port). Sixty-two episodes (24%) were triaged as high-risk and admitted for inpatient management; five (8%) had positive blood cultures. The remaining 192 episodes were triaged as low risk and managed with once daily outpatient intravenous ceftriaxone; three (1.6%) were associated with bacteremia, and 10% required eventual inpatient management. Of all the factors analyzed, only signs of sepsis (lethargy, chills, hypotension) were associated with positive bloodstream infection.
  
  
  CONCLUSIONS
  Treatment of a defined subset of patients with outpatient intravenous ceftriaxone was safe and effective. Signs of sepsis were the only factor significantly associated with bloodstream infection. This study provides a baseline for future prospective studies assessing the safety of withholding antibiotics in this subset of patients.
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.|Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Bilal Abou
authors.initials: BA
authors.lastname: Ali
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Nader
authors.initials: N
authors.lastname: Hirmas
authors.affiliation: Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Merabi
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Rima
authors.initials: R
authors.lastname: Hanna-Wakim
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.|Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Samar
authors.initials: S
authors.lastname: Muwakkit
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.|Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Miguel
authors.initials: M
authors.lastname: Abboud
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.|Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hassan El
authors.initials: HE
authors.lastname: Solh
authors.affiliation: Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.|Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Raya
authors.initials: R
authors.lastname: Saab
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000188:drug therapy*; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002443:Ceftriaxone
keywords: bacteremia; fever; non-neutropenic