Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative

Jeremy Rosenblum, Juan Lin, Mimi Kim, Adam S. Levy

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists. Procedure: To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009. Results: We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4%). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9%), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48hours prior to onset of fever. Conclusions: In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10% of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48hours prior to the onset of fever.

Original languageEnglish (US)
Pages (from-to)923-927
Number of pages5
JournalPediatric Blood and Cancer
Volume60
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Fever
Bacteremia
Febrile Neutropenia
Hospitalization
Growth
Blood Culture
Pediatrics
Hematology
Anti-Bacterial Agents

Keywords

  • Bacteremia
  • Blood culture
  • Febrile neutropenia

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

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title = "Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative",
abstract = "Background: Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists. Procedure: To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009. Results: We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4{\%}). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9{\%}), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48hours prior to onset of fever. Conclusions: In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10{\%} of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48hours prior to the onset of fever.",
keywords = "Bacteremia, Blood culture, Febrile neutropenia",
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T1 - Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative

AU - Rosenblum, Jeremy

AU - Lin, Juan

AU - Kim, Mimi

AU - Levy, Adam S.

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N2 - Background: Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists. Procedure: To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009. Results: We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4%). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9%), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48hours prior to onset of fever. Conclusions: In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10% of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48hours prior to the onset of fever.

AB - Background: Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists. Procedure: To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009. Results: We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4%). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9%), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48hours prior to onset of fever. Conclusions: In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10% of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48hours prior to the onset of fever.

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