372 - Predictors of invasive bacterial infection in febrile oncology patients attended in the Emergency Department

Poster Number: 372
Publication Number: 372.206

Borja Gomez, Pediatric Emergency Department. Cruces University Hospital, Barakaldo, Pais Vasco, Spain; Amaia Fernandez, Cruces University Hospital, BILBAO, Pais Vasco, Spain; Idoia Rius, Cruces University Hospital, Bilbao, Pais Vasco, Spain; Ricardo López Almaraz, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Pais Vasco, Spain; Santiago Mintegi, Hospital Universitario Cruces, Bilbao, Pais Vasco, Spain

Background: fever in oncology patients receiving chemotherapy is a true emergency because of their high risk of presenting and invasive bacterial infection (IBI). New approaches have been developed in order to predict this risk and to allow a more individualized management.

Objective: to identify clinical and analytical factors predictors of IBI in febrile oncology patients attended in the Pediatric Emergency Department (PED).

Design/Methods: prospective observational study of the oncology patients receiving chemotherapy who attended the PED of a tertiary teaching hospital between 2016 and 2020. We defined IBI as the growth of:
- a bacterial pathogen in blood, cerebrospinal fluid or any other sterile fluid
- a bacterium commonly considered contaminant in two blood cultures obtained simultaneously from a peripheral vein and a central venous catheter, usually port-a-cath, or in two different samples obtained from a central venous catheter (catheter-related bloodstream infection: CRBSI).
We performed a multivariate analysis including sex, age, general appearance, type of cancer [high-risk hematologic malignancies (acute lymphoblastic leukemia or non-Hodgkin lymphoma in induction/reinduction/consolidation phase or relapsed and acute myeloid leukemia in any phase), low risk hematologic malignancies and solid tumors], fever degree, absolute neutrophil and monocyte counts and C-reactive protein and procalcitonin (PCT) values.

Results: among 347 episodes, 52 IBIs were diagnosed (prevalence 14.9%): 29 CRBSI, 13 sepsis/septic shocks, 9 bacteremias and 1 bacterial meningitis. No patient died or had any sequela. In 25 episodes (7.2%), the patient required admission to the Pediatric Intensive Care Unit (PICU); 15 of them with a final diagnosis of IBI.
We identified three independent predictors of IBI: high-risk hematologic malignancies (OR 5.66 [95%IC 1.84-24.8]), monocyte count (OR 0.85 [95%IC 0.71-0.98]) and PCT value (OR 1.04 [95%IC 1.02-1.08]).
IBI prevalence among the 103 episodes (29.6%) with no high-risk hematologic malignancies, a PCT value < 0.5 ng/mL and a monocyte count ≥100/mcL was 5.8%. These three factors identified 46 of the 52 IBIs (sensitivity: 88.5% [77.0-94.6%]), including all the sepsis/septic shocks and the bacterial meningitis and all the patients who required admission to PICU.Conclusion(s): the kind of cancer, the PCT value and the monocyte count predict the risk of IBI among oncology patients receiving chemotherapy attended with fever. These three factors can guide initial clinical decision-making.