Evaluation of empiric vancomycin therapy in children with fever and neutropenia

A retrospective evaluation was conducted to determine which children admitt ed for fever and neutropenia required empiric vancomycin therapy, and to de velop a clinical pathway for appropriate treatment. Chart review identified 109 admissions of 36 pediatric oncology patients for fever and neutropenia , of which 88 were eligible for analysis. Blood cultures isolated 17 gram-p ositive organisms; coagulase-negative staphylococci and viridans group stre ptococci were cultured most frequently (82%). We concluded that previous hi gh-dose cytarabine therapy, inflamed central access site, and hypotension o r septic shock are possible indicators of febrile, neutropenic patients at high risk for gram-positive pathogen isolation. These predictors then were used to determine which children would receive empiric vancomycin therapy.