Risk Factors of Serious Bacterial Infection in Previously Healthy Children Older Than 90 Days Old With Fever and Neutropenia

医学 菌血症 优势比 中性粒细胞减少症 内科学 蜂窝织炎 置信区间 入射(几何) 中性粒细胞绝对计数 前瞻性队列研究 外科 抗生素 光学 物理 微生物学 生物 毒性
作者
Andrea Mora-Capín,Jorge Lorente‐Romero,Alicia Hernanz‐Lobo,Arístides Rivas García,Paula Vázquez-López,Paula Carrascosa-García,Andrés González-Hermosa,Juncal Mena-Huarte,María Amalia Pérez-Saez,Gemma Marfany i Nadal,Irene García-de-Diego,Rafael Marañón-Pardillo
出处
期刊:Pediatric emergency care [Lippincott Williams & Wilkins]
卷期号:38 (7): e1378-e1383 被引量:2
标识
DOI:10.1097/pec.0000000000002758
摘要

The main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs).This is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected.One hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/μL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI.None of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/μL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.
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