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A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients
Background Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count
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| Published in: | Pediatric blood & cancer 2024-03, Vol.71 (3), p.e30818-n/a |
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| container_title | Pediatric blood & cancer |
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| creator | Whitehurst, Daniel A. Friedman, Debra L. Zhao, Zhiguo Sarma, Asha Snyder, Elizabeth Dulek, Daniel E. Banerjee, Ritu Kitko, Carrie L. Esbenshade, Adam J. |
| description | Background
Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count |
| doi_str_mv | 10.1002/pbc.30818 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2903860381</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2903860381</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3138-e805d71a0c312817d5c0be7aa998ed2774e9049d81e5c23b05066c2326c3e5de3</originalsourceid><addsrcrecordid>eNp1kE1LxDAQhoMorl8H_4AEvOhhddJu2vSoi18g6EHPJU1nd7O0SU3alf33jq56EDyEmWGePAwvY8cCLgRActlV5iIFJdQW2xNyIscSRL7920MxYvsxLgnNQKpdNkqVECCLyR6zV9z4tgu4QBftCrmOEWNs0fXcz3i_QN4F33g3x5rPsAq2Qe5w6IPv0FnNcaWbQffWO24d77C2ug_WcO8MfZuveUdLssVDtjPTTcSj73rAXm9vXqb348enu4fp1ePYpCJVY1Qg61xooDFRIq-lgQpzrYtCYZ3k-QQLmBS1EihNklYgIcuoSTKToqwxPWBnGy_d_TZg7MvWRoNNox36IZZJAanK6AlCT_-gSz8ER9cRJXIyg8qJOt9QJvgYA87KLthWh3UpoPzMv6T8y6_8iT35Ng5Vi_Uv-RM4AZcb4J2CXP9vKp-vpxvlB7Xsj5E</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2917506087</pqid></control><display><type>article</type><title>A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients</title><source>Wiley</source><creator>Whitehurst, Daniel A. ; Friedman, Debra L. ; Zhao, Zhiguo ; Sarma, Asha ; Snyder, Elizabeth ; Dulek, Daniel E. ; Banerjee, Ritu ; Kitko, Carrie L. ; Esbenshade, Adam J.</creator><creatorcontrib>Whitehurst, Daniel A. ; Friedman, Debra L. ; Zhao, Zhiguo ; Sarma, Asha ; Snyder, Elizabeth ; Dulek, Daniel E. ; Banerjee, Ritu ; Kitko, Carrie L. ; Esbenshade, Adam J.</creatorcontrib><description>Background
Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta‐D‐glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population.
Methods
In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005‐2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified.
Results
In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non‐IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice.
Conclusions
Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.30818</identifier><identifier>PMID: 38110594</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Abdomen ; Bronchus ; Chest ; Colitis ; Computed tomography ; Diagnosis ; Infections ; Lavage ; Leukocytes (neutrophilic) ; Neutropenia ; Oncology ; Patients ; Pediatrics ; Pelvis ; Pneumonia ; Sinus ; Sinuses ; Sinusitis ; Stem cell transplantation</subject><ispartof>Pediatric blood & cancer, 2024-03, Vol.71 (3), p.e30818-n/a</ispartof><rights>2023 Wiley Periodicals LLC.</rights><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3138-e805d71a0c312817d5c0be7aa998ed2774e9049d81e5c23b05066c2326c3e5de3</cites><orcidid>0000-0002-0154-4996 ; 0000-0001-9216-2901</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38110594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Whitehurst, Daniel A.</creatorcontrib><creatorcontrib>Friedman, Debra L.</creatorcontrib><creatorcontrib>Zhao, Zhiguo</creatorcontrib><creatorcontrib>Sarma, Asha</creatorcontrib><creatorcontrib>Snyder, Elizabeth</creatorcontrib><creatorcontrib>Dulek, Daniel E.</creatorcontrib><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Kitko, Carrie L.</creatorcontrib><creatorcontrib>Esbenshade, Adam J.</creatorcontrib><title>A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients</title><title>Pediatric blood & cancer</title><addtitle>Pediatr Blood Cancer</addtitle><description>Background
Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta‐D‐glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population.
Methods
In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005‐2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified.
Results
In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non‐IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice.
Conclusions
Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.</description><subject>Abdomen</subject><subject>Bronchus</subject><subject>Chest</subject><subject>Colitis</subject><subject>Computed tomography</subject><subject>Diagnosis</subject><subject>Infections</subject><subject>Lavage</subject><subject>Leukocytes (neutrophilic)</subject><subject>Neutropenia</subject><subject>Oncology</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pelvis</subject><subject>Pneumonia</subject><subject>Sinus</subject><subject>Sinuses</subject><subject>Sinusitis</subject><subject>Stem cell transplantation</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp1kE1LxDAQhoMorl8H_4AEvOhhddJu2vSoi18g6EHPJU1nd7O0SU3alf33jq56EDyEmWGePAwvY8cCLgRActlV5iIFJdQW2xNyIscSRL7920MxYvsxLgnNQKpdNkqVECCLyR6zV9z4tgu4QBftCrmOEWNs0fXcz3i_QN4F33g3x5rPsAq2Qe5w6IPv0FnNcaWbQffWO24d77C2ug_WcO8MfZuveUdLssVDtjPTTcSj73rAXm9vXqb348enu4fp1ePYpCJVY1Qg61xooDFRIq-lgQpzrYtCYZ3k-QQLmBS1EihNklYgIcuoSTKToqwxPWBnGy_d_TZg7MvWRoNNox36IZZJAanK6AlCT_-gSz8ER9cRJXIyg8qJOt9QJvgYA87KLthWh3UpoPzMv6T8y6_8iT35Ng5Vi_Uv-RM4AZcb4J2CXP9vKp-vpxvlB7Xsj5E</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Whitehurst, Daniel A.</creator><creator>Friedman, Debra L.</creator><creator>Zhao, Zhiguo</creator><creator>Sarma, Asha</creator><creator>Snyder, Elizabeth</creator><creator>Dulek, Daniel E.</creator><creator>Banerjee, Ritu</creator><creator>Kitko, Carrie L.</creator><creator>Esbenshade, Adam J.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0154-4996</orcidid><orcidid>https://orcid.org/0000-0001-9216-2901</orcidid></search><sort><creationdate>202403</creationdate><title>A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients</title><author>Whitehurst, Daniel A. ; Friedman, Debra L. ; Zhao, Zhiguo ; Sarma, Asha ; Snyder, Elizabeth ; Dulek, Daniel E. ; Banerjee, Ritu ; Kitko, Carrie L. ; Esbenshade, Adam J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3138-e805d71a0c312817d5c0be7aa998ed2774e9049d81e5c23b05066c2326c3e5de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdomen</topic><topic>Bronchus</topic><topic>Chest</topic><topic>Colitis</topic><topic>Computed tomography</topic><topic>Diagnosis</topic><topic>Infections</topic><topic>Lavage</topic><topic>Leukocytes (neutrophilic)</topic><topic>Neutropenia</topic><topic>Oncology</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pelvis</topic><topic>Pneumonia</topic><topic>Sinus</topic><topic>Sinuses</topic><topic>Sinusitis</topic><topic>Stem cell transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Whitehurst, Daniel A.</creatorcontrib><creatorcontrib>Friedman, Debra L.</creatorcontrib><creatorcontrib>Zhao, Zhiguo</creatorcontrib><creatorcontrib>Sarma, Asha</creatorcontrib><creatorcontrib>Snyder, Elizabeth</creatorcontrib><creatorcontrib>Dulek, Daniel E.</creatorcontrib><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Kitko, Carrie L.</creatorcontrib><creatorcontrib>Esbenshade, Adam J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Whitehurst, Daniel A.</au><au>Friedman, Debra L.</au><au>Zhao, Zhiguo</au><au>Sarma, Asha</au><au>Snyder, Elizabeth</au><au>Dulek, Daniel E.</au><au>Banerjee, Ritu</au><au>Kitko, Carrie L.</au><au>Esbenshade, Adam J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr Blood Cancer</addtitle><date>2024-03</date><risdate>2024</risdate><volume>71</volume><issue>3</issue><spage>e30818</spage><epage>n/a</epage><pages>e30818-n/a</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Background
Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta‐D‐glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population.
Methods
In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005‐2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified.
Results
In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non‐IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice.
Conclusions
Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38110594</pmid><doi>10.1002/pbc.30818</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0154-4996</orcidid><orcidid>https://orcid.org/0000-0001-9216-2901</orcidid></addata></record> |
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| subjects | Abdomen Bronchus Chest Colitis Computed tomography Diagnosis Infections Lavage Leukocytes (neutrophilic) Neutropenia Oncology Patients Pediatrics Pelvis Pneumonia Sinus Sinuses Sinusitis Stem cell transplantation |
| title | A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients |
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