Evaluating the Importance of Paired Central and Peripheral Blood Cultures in Pediatric Oncology Patients Presenting with Febrile Neutropenia
Emma Yackley, Arthur Chang, Lee Junghyae, Melissa Acquazzino, Kari NeemannAbstract
Background
In the initial management of fever in neutropenic children with cancer, the collection of blood cultures (BC) helps guide antimicrobial therapy and identify blood stream infections (BSI). Most pediatric oncology patients possess central venous catheters, and the utility of obtaining concurrent peripheral and central BC is unclear in this population. The aim of this study was to examine the role of peripheral BC in identifying BSI in pediatric neutropenic oncology patients.
Methods
A retrospective chart review was performed to identify hospitalized pediatric oncology patients with a central venous access device (CVAD) recorded who were treated for febrile neutropenia over a 10-year period. Per institutional practices paired central and peripheral blood cultures (BC) sets were drawn upon recognition of FN and before empiric antibiotics were administered. Episodes with at least one positive BC and that were considered true BSI were grouped according to whether the set had concordant positive central and peripheral BCs, an isolated positive central BC, or an isolated positive peripheral BC. The volume and time to positivity of the samples was recorded.
Results
A total of 419 FN episodes were captured, of which 55 episodes (13.1%) met the criteria for true BSI, as indicated by at least one positive BC from a paired set of peripheral and central BC. Of the 55 episodes, 27 (49.1%) exhibited concordant positive blood cultures, 15 (27.3%) had isolated positive central blood cultures, and 13 (23.6%) had isolated positive peripheral blood cultures.
Conclusions
The proportion of bloodstream infections identified solely through peripheral draws was 23.6%, surpassing previous reports. This highlights the critical importance of obtaining paired blood cultures in the initial management of fever in neutropenic children with cancer, underscoring the need for vigilant diagnostic practices to ensure timely and effective treatment.