Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.
National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
J Pediatric Infect Dis Soc. 2021 Mar 26;10(2):125-130. doi: 10.1093/jpids/piaa029.
The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics.
Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken.
A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures.
In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.
癌症合并发热性中性粒细胞减少症（FN）患儿重复血培养（BC）的时机和必要性尚不清楚。我们评估了经验性 FN 抗生素治疗前后采集的 BC 的诊断效果。
使用前瞻性收集的来自澳大利亚预测癌症儿童感染并发症（PICNICC）研究的数据。诊断效果以 FN 发作中有真正血流感染（BSI）的数量除以进行了 BC 的 FN 发作数量来计算。
858 例 FN 发作中，13%的患者发现 BSI。抗生素前 BC 的诊断效果优于抗生素后培养（12.3%比 4.4%，P<0.001）。三分之二的抗生素后 BSI 与新发热或临床不稳定有关，仅在使用经验性抗生素 48 小时后仍持续发热时才发现 2 例新 BSI。抗生素后培养中更常发现污染的 BC。
在无新发热或临床不稳定的情况下，持续发热 48 小时以上的 BC 培养效果有限。在该人群中，优化 BC 采集并减少对患者、医护人员和医院造成不必要检测负担的机会存在。
