The Children's Cancer Centre, The Royal Children's Hospital Parkville, Parkville, Victoria, Australia.
Department of Pediatrics, Vanderbilt University Medical Centre, Nashville, Tennessee, USA.
Pediatr Blood Cancer. 2022 Dec;69(12):e29931. doi: 10.1002/pbc.29931. Epub 2022 Aug 28.
Fever and infection are an important complication of childhood cancer therapy. Most research and guideline development has focussed on febrile neutropenia, with a paucity directed at non-neutropenic fever (NNF). We describe the clinical presentation, management and outcomes of NNF in children with cancer, and externally validate the Esbenshade Vanderbilt (EsVan) clinical decision rules (CDR) to predict bacteraemia.
Using a prospective database, retrospective data were collected on consecutive NNF episodes (fever ≥38.0°C and absolute neutrophil count >1.0 cells/mm ). Sensitivity, specificity and area under the receiver operator characteristic curve (AUC-ROC) of the CDR were compared to derivation study.
There were 203 NNF episodes occurring in 125 patients. Severe sepsis was uncommon (n = 2, 1%) and bacteraemia occurred in 10 (4.9%, 95% confidence interval [CI]: 2.7%-8.8%) episodes. A confirmed or presumed bacterial infection requiring antibiotics occurred in 31 (15%) patients. Total 202 (99%) episodes received at least one dose of intravenous broad-spectrum antibiotic and 141 (70%) episodes were admitted to hospital. Six (3%) episodes required intensive care unit (ICU)-level care and there were no infection-related deaths. The EsVan 1 rule had an AUC-ROC of 0.67, 80% were identified as low risk, and sensitivity and specificity were 50% and 81.5%, respectively, for a risk threshold of 10%.
Serious infection and adverse outcome are uncommon in children with NNF. Many children did not have a bacterial cause of infection identified, but were still treated with broad-spectrum antibiotics and admitted to hospital. National clinical practice guidelines should be developed for this important cohort to enable risk stratification and optimise antibiotic management. Further research is required to determine appropriateness of EsVan CDR in our cohort.
发热和感染是儿童癌症治疗的一个重要并发症。大多数研究和指南制定都集中在发热性中性粒细胞减少症上，而对非中性粒细胞减少性发热（NNF）的研究较少。我们描述了癌症患儿 NNF 的临床表现、治疗方法和结局，并对外科恩德沙凡德（EsVan）临床决策规则（CDR）预测菌血症的能力进行了外部验证。
使用前瞻性数据库，回顾性收集连续 NNF 发作（体温≥38.0°C 和绝对中性粒细胞计数>1.0 个细胞/mm）的数据。将 CDR 的敏感性、特异性和受试者工作特征曲线下面积（AUC-ROC）与原始研究进行比较。
共有 125 例患者发生 203 次 NNF 发作。严重脓毒症少见（n=2，1%），10 次（4.9%，95%置信区间[CI]：2.7%-8.8%）发作中发生菌血症。31 例（15%）患者存在经证实或疑似需要抗生素治疗的细菌感染。202 例（99%）患者至少接受了一剂静脉广谱抗生素治疗，141 例（70%）患者住院。6 例（3%）患者需要重症监护病房（ICU）级别的治疗，无感染相关死亡。EsVan 1 规则的 AUC-ROC 为 0.67，80%被确定为低风险，风险阈值为 10%时，敏感性和特异性分别为 50%和 81.5%。
NNF 患儿发生严重感染和不良结局的情况并不常见。许多患儿未发现细菌感染的原因，但仍接受了广谱抗生素治疗并住院治疗。应制定针对这一重要患者群体的国家临床实践指南，以实现风险分层并优化抗生素管理。需要进一步研究以确定 EsVan CDR 在本队列中的适用性。
