Moskalewicz Risha L, Isenalumhe Leidy L, Luu Cindy, Wee Choo Phei, Nager Alan L
Division of Emergency Medicine, Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, MN.
Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
Am J Emerg Med. 2017 Jan;35(1):20-24. doi: 10.1016/j.ajem.2016.09.028. Epub 2016 Sep 17.
To examine clinical characteristics associated with bacteremia in febrile nonneutropenic pediatric oncology patients with central venous catheters (CVCs) in the emergency department (ED).
Fever is the primary reason pediatric oncology patients present to the ED. The literature states that 0.9% to 39% of febrile nonneutropenic oncology patients are bacteremic, yet few studies have investigated infectious risk factors in this population.
This was a retrospective cohort study in a pediatric ED, reviewing medical records from 2002 to 2014. Inclusion criteria were patients with cancer, temperature at least 38°C, presence of a CVC, absolute neutrophil count greater than 500 cells/μL, and age less than 22 years. Exclusion criteria were repeat ED visits within 72 hours, bloodwork results not reported by the laboratory, and patients without oncologic history documented at the study hospital. The primary outcome measure is a positive blood culture (+BC). Other variables include age, sex, CVC type, cancer diagnosis, absolute neutrophil count, vital signs, upper respiratory infection (URI) symptoms, and amount of intravenous (IV) normal saline (NS) administered in the ED. Data were analyzed using descriptive statistics and a multiple logistic regression model.
A total of 1322 ED visits were sampled, with 534 enrolled, and 39 visits had +BC (7.3%). Variables associated with an increased risk of +BC included the following: absence of URI symptoms (odds ratio [OR], 2.30; 95% CI, 1.13-4.69), neuroblastoma (OR, 3.65; 95% CI, 1.47-9.09), "other" cancer diagnosis (OR, 4.56; 95% CI, 1.93-10.76), tunneled externalized CVC (OR, 5.04; 95% CI, 2.25-11.28), and receiving at least 20 mL/kg IV NS (OR, 2.34; 95% CI, 1.2-4.55). The results of a multiple logistic regression model also showed these variables to be associated with +BC.
The absence of URI symptoms, presence of an externalized CVC, neuroblastoma or other cancer diagnosis, and receiving at least 20 mL/kg IV NS in the ED are associated with increased risk of bacteremia in nonneutropenic pediatric oncology patients with a CVC.
探讨急诊科（ED）中伴有中心静脉导管（CVC）的发热性非中性粒细胞减少儿科肿瘤患者菌血症的临床特征。
发热是儿科肿瘤患者前往急诊科就诊的主要原因。文献表明，0.9%至39%的发热性非中性粒细胞减少肿瘤患者存在菌血症，但很少有研究调查该人群的感染危险因素。
这是一项在儿科急诊科进行的回顾性队列研究，回顾了2002年至2014年的病历。纳入标准为患有癌症、体温至少38°C、存在CVC、绝对中性粒细胞计数大于500个细胞/μL且年龄小于22岁。排除标准为72小时内再次前往急诊科就诊、实验室未报告血液检查结果以及研究医院未记录肿瘤病史的患者。主要结局指标是血培养阳性（+BC）。其他变量包括年龄、性别、CVC类型、癌症诊断、绝对中性粒细胞计数、生命体征、上呼吸道感染（URI）症状以及在急诊科给予的静脉注射（IV）生理盐水（NS）量。数据采用描述性统计和多元逻辑回归模型进行分析。
共抽取了1322次急诊科就诊病例，534例纳入研究，39例血培养阳性（7.3%）。与血培养阳性风险增加相关的变量包括：无URI症状（比值比[OR]，2.30；95%可信区间[CI]，1.13 - 4.69）、神经母细胞瘤（OR，3.65；95%CI，1.47 - 9.09）、“其他”癌症诊断（OR，4.56；95%CI，1.93 - 10.76）、隧道式外置CVC（OR，5.04；95%CI，2.25 - 11.28）以及在急诊科接受至少20 mL/kg的静脉注射NS（OR，2.34；95%CI，1.2 - 4.55）。多元逻辑回归模型的结果也显示这些变量与血培养阳性相关。
无URI症状、存在外置CVC、神经母细胞瘤或其他癌症诊断以及在急诊科接受至少20 mL/kg的静脉注射NS与伴有CVC的非中性粒细胞减少儿科肿瘤患者菌血症风险增加相关。
