A clinical approach to non-neutropenic fever in children with cancer

• Published in: Journal of oncology pharmacy practice 2021-04, Vol.27 (3), p.560-569
• Main Authors: AlAzmi, Aeshah, Jastaniah, Wasil, AlDabbagh, Mona, Elimam, Naglla
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Bacteremia; Bacteremia - drug therapy; Bacteremia - epidemiology; C-reactive protein; C-Reactive Protein - analysis; Cancer; Catheter-Related Infections - drug therapy; Catheter-Related Infections - etiology; Catheters; Ceftriaxone; Ceftriaxone - therapeutic use; Central Venous Catheters - adverse effects; Child; Child, Preschool; Children; Disease Management; Female; Fever; Fever - complications; Fever - drug therapy; Humans; Infant; Infant, Newborn; Male; Neoplasms - complications; Neutropenia; Respiration Disorders - complications; Respiration Disorders - therapy; Retrospective Studies; Risk Factors
• ISSN: 1078-1552; 1477-092X
• DOI: 10.1177/1078155220925161

Background There are a limited number of studies that address non-neutropenic fever episodes in children with cancer, and no standard approach exists. Method We opt to retrospectively analyze the efficacy of the current clinical approach for management of non-neutropenic fever episodes and the associated risk factors among children with cancer at the Princess Noorah Oncology Center from May 2016 through December 2017. Results A total of 480 non-neutropenic fever episodes were identified in 131 children, of which 62 episodes were triaged as high-risk non-neutropenic fever and 418 as low-risk non-neutropenic fever. Of those 480 non-neutropenic fever, 361 episodes (75.2%) were associated with the presence of central venous catheters. The overall failure rate of ceftriaxone mono-therapy was observed in 75.6% (11.7% in high-risk non-neutropenic fever with a mean C-reactive protein level of 21.1 (±23.2) mmol/L and 63.9% in low-risk non-neutropenic fever with a mean C-reactive protein level of 17.6 (±53.9) mmol/L). The overall bacteremia rate was 14.4%. The type of organisms isolated was mainly high-risk organisms in 59 non-neutropenic fever episodes (85.5%), OR 1.78 (95% CI: 0.45–7.04) p = 0.41. Of note, all bacteremia were associated with the presence of central venous catheter (100%). Of all the examined risk factors of outpatient treatment failure in low-risk non-neutropenic fever, only prolonged fever of more than three days were significantly associated with bacteremia OR 8.107 [95% CI: 1.744–37.691], p = 0.008. Noteworthy is that almost 43% of non-neutropenic fever episodes were associated with respiratory symptoms. This study provides a baseline for future prospective research assessing the pattern of non-neutropenic fever by focusing on associated risk factors.