PREDICTING THE RISK OF BACTEREMIA IN CHILDREN WITH FEVER AND NEUTROPENIA

Purpose: We sought to identify factors assessable at the time of admis sion for fever and neutropenia that predict bacteremia in children wit h cancer. Patients and Methods: One hundred fifteen consecutive episod es of fever and absolute neutrophil count (ANC) less than 500/mu L in 72 children with cancer were studied prospectively to determine the ri sk of bacteremia using data assessable at the time of presentation. Af ter exploratory analysis identified admission temperature and absolute monocyte count (AMoC) as the strongest predictive factors, recursive partitioning wets used to determine cutpoints for these variables that resulted in discrimination between episodes associated with a lower o r higher risk of bacteremia. Results: There were 24 episodes of bacter emia (21% of episodes), Episodes were grouped using the cutpoints for AMoC and temperature: 17% were classified as low risk for bacteremia ( AMoC greater than or equal to 100/mu L), 65% as intermediate risk (AMo C < 100/mu L and temperature < 39.0 degrees C), and 18% as high risk ( AMoC < 100/mu L and temperature greater than or equal to 39.0 degrees C). No episodes classified as low risk were associated with bacteremia ; 19% of intermediate-risk and 48% of high-risk episodes were associat ed with bacteremia. The odds ratio of bacteremia for the high-risk ver sus the intermediate-risk group is 4.4 (95% confidence interval, 1.6 t o 12.9). The risk classification was validated using data from 57 diff erent episodes of fever and neutropenia treated in the same hospital. Conclusion: Three levels of risk for bacteremia are defined the AMoC a nd temperature at the time of admission for fever and neutropenia. Tri als now should be conducted to test whether these factors may be used to assign some children to less intensive or outpatient antibiotic the rapy at the time of presentation with fever and neutropenia. (C) 1996 by American Society of Clinical Oncology.