Conflict of interest: Nothing to declare.
Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative†
Article first published online: 9 OCT 2012
Copyright © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 60, Issue 6, pages 923–927, June 2013
How to Cite
Rosenblum, J., Lin, J., Kim, M. and Levy, A. S. (2013), Repeating blood cultures in neutropenic children with persistent fevers when the initial blood culture is negative. Pediatr. Blood Cancer, 60: 923–927. doi: 10.1002/pbc.24358
- Issue published online: 16 APR 2013
- Article first published online: 9 OCT 2012
- Manuscript Accepted: 11 SEP 2012
- Manuscript Received: 30 JUL 2012
- febrile neutropenia;
- blood culture
Febrile neutropenia is a common reason for the hospitalization of pediatric oncology patients. The initiation of antibiotics and the overall decline in rates of bacteremia, would predict a low yield of detection of bacteremia in repeated blood cultures. Despite little evidence supporting the utility of serial cultures, repeat culturing with fever persists.
To determine the rate of follow-up blood culture growth when the initial blood culture showed no bacterial growth and patient risk factors for this occurrence, we reviewed the records of oncology patients admitted to the Children's Hospital at Montefiore Pediatric Hematology/Oncology service for febrile neutropenia from 2004 to 2009.
We identified 457 febrile neutropenia episodes in 137 patients. The initial blood culture was positive in 84 episodes (18.4%). In 220 episodes comprising 105 patients, the initial blood culture was negative and a subsequent culture was obtained. In 24 episodes (10.9%), bacterial growth was detected in the repeat culture. Risk factors included a previous history of bacteremia and hospitalization for more than 48 hours prior to onset of fever.
In patients with febrile neutropenia, bacteremia is detected nearly twice as frequently in initial blood cultures than in repeat blood cultures obtained when the initial blood culture is negative. Despite an initial negative blood culture, bacteremia can be detected in more than 10% of episodes when a repeat blood culture is obtained. The risk more than doubles for patients with a previous history of bacteremia or hospitalized for more than 48 hours prior to the onset of fever. Pediatr Blood Cancer 2013; 60: 923–927. © 2012 Wiley Periodicals, Inc.