title: Repeated Blood Cultures in Pediatric Febrile Neutropenia: Would Following the Guidelines Alter the Outcome?
abstract: The Infectious Diseases Society of America (IDSA) guidelines recommend collecting blood cultures for the first 3 days of febrile neutropenia (FN) in the clinically stable oncology patient with persistent fevers. Nonetheless, many physicians send daily blood cultures beyond 3 days, and the impact of that practice is uncertain.
  
  
  
  We reviewed pediatric FN episodes from July 2009 to May 2014 at University of Chicago Comer Children's Hospital. For each positive culture, we determined if it was a pathogen or a contaminant. We reviewed episode and patient demographics to identify risk factors for subsequent positive blood cultures in the setting of an initially negative culture.
  
  
  
  We identified 381 episodes of FN in 162 patients. Of those, 87 had a positive blood culture on day 1 (21.0% incidence of bacteremia). Of 294 episodes with a negative blood culture on day 1, six (2.04%, 95% confidence interval [CI] 0.42-3.67) had a positive culture after day 3. Of those, three were pathogens (1.02%, 95%CI -0.14 to 2.18), and only one was found in a hemodynamically stable patient (0.34%, 95%CI -0.33 to 1.01) with new mucositis. In the other two patients, Escherichia coli was isolated from blood cultures after day 10 in the setting of significant hemodynamic changes. Risk factor analysis performed in stable patients yielded nonsignificant results.
  
  
  
  Of 294 FN episodes with an initial negative blood culture, only one episode of bacteremia occurred without hemodynamic changes past day 3, supporting the IDSA guidelines to discontinue blood cultures in stable FN patients after day 3.
authors.affiliation: Department of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Petty
authors.affiliation: Department of Pediatric Hematology Oncology, University of Chicago Medical Center/Comer Children's Hospital, Chicago, Illinois.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sokol
authors.affiliation: Department of Pediatric Infectious Diseases, University of Chicago Medical Center/Comer Children's Hospital, Chicago, Illinois.
authors.forename: Allison H
authors.initials: AH
authors.lastname: Bartlett
authors.affiliation: Department of Pediatric Hematology Oncology, University of Chicago Medical Center/Comer Children's Hospital, Chicago, Illinois.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: McNeer
authors.affiliation: Chief of Section of Infectious Diseases, Allergy, Immunology, and Rheumatology, Nemours Children's Hospital, Orlando, Florida.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Alexander
authors.affiliation: Department of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pisano
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D000071997:Blood Culture; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male
keywords: febrile neutropenia; infections in immunocompromised hosts; pediatric oncology