Negative Blood Cultures Associated-outcome in Patients With Febrile Neutropenia Admitted to the Intensive Care Unit
Ana Carolina Carvalho, Cinthia Kioki, Ana Carolina Prince, Talita Bueno, Eliane Francelino, Marcelo Milone SilvaAbstract
Background
Febrile neutropenia is a common and serious complication in patients undergoing chemotherapy which requires immediate treatment. Knowledge of microorganisms involved in episodes of febrile neutropenia and their sensitivity profile is extremely important for successful and timely antimicrobial therapy. Our aim was to understand the role of blood culture results in patients with febrile neutropenia outcome.
Methods
Patients admitted with febrile neutropenia to a pediatric oncology referral center in São José dos Campos, Brazil, from January 2022 to October 2024 were retrospectively evaluated. They were stratified according to: underlying oncological diagnosis, blood culture positivity, intensive care unit (ICU) admission and outcome. Febrile neutropenia was defined as temperature ≥ 37.8° C associated with an absolute neutrophil count ≤ 500 cels/mm3. All patients had blood cultures processed using the BD BACTEC™ FX device (BD, New Jersey, NJ, USA). When positive, microorganisms isolates had their identification and antimicrobial susceptibility profiles defined using VITEK 2™ (Biomérieux, Marcy-l'Étoile, France).
Results
There were 189 admissions of patients aged 0-21 years for febrile neutropenia in the study period. Underlying diagnosis were acute lymphoid leukemia (34.9%), solid tumors (25.4%), central nervous system (CNS) tumors (16,4%) and acute myeloid leukemia (10.58%). Sixteen patients were admitted to ICU (8,5%). In 22,2% of cases, blood cultures were positive, with 50% blood culture positivity among patients admitted to the ICU. A gram-negative bacillus was isolated in 64,3% of the positive blood culture samples. Patients admitted to ICU with negative blood cultures died in 37,5% of cases, compared to 25% of deaths among patients with positive blood cultures (Odds ratio (OR)=1.8).
Conclusions
In our study we found an increased OR of death outcome among febrile neutropenic patients admitted to ICU with negative blood cultures. The use of additional diagnostic methods to guide antimicrobial therapy in this group might be necessary.