PED FEB NEUT X RECOVERY

Safety of discharge for children with cancer and febrile neutropenia off antibiotics using absolute neutrophil count threshold values as a surrogate marker for adequate bone marrow recovery

Authors

• First published: 8 November 2017Full publication history
• DOI: 10.1002/pbc.26875  View/save citation
• Cited by (CrossRef): 0 articlesCheck for updates
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• Funding Information

• Funding information Grant sponsor: NCRR/NIH; Grant numbers CA090625 and KL2TR000446; Grant sponsor: NCI/NIH; Grant number: 2P30CA068485-19.

Abstract

Background

Febrile neutropenia (F&N) is common among pediatric oncology patients. However, there is a lack of clarity regarding parameters whereby such patients have demonstrated adequate bone marrow recovery for hospital discharge and empiric antibiotic discontinuation.

Procedure

A retrospective review was performed for 350 episodes of F&N occurring at a single institution between 2007 and 2012 in pediatric oncology patients who were afebrile for 24 hr and had no bacterial source identified. Seven-day postdischarge outcomes were assessed and compared based on absolute neutrophil count (ANC) at discharge in order to identify an optimal threshold.

Results

Overall, 7-day readmission rates were low (17/350, 4.6%), with patients discharged with post-nadir ANC of 100–199/μl (2/51, 3.9%), 200–499/μl (5/125, 4.0%), and ≥500/μl (8/160, 5.0%), all having similar rates. Patients with a discharge ANC < 100/μl (2/14, 14.3%) had a higher readmission rate. A new bloodstream infection was identified upon readmission in one patient in each discharge ANC range except for ANC of 100–199/μl, in which none occurred. In a subset of 217 episodes where the ANC fell below 200/μl during the admission and subsequently rose above 100/μl, 94 episodes resulted in 126 additional hospital days while subjects awaited further count recovery. One death occurred in a patient whose ANC at discharge was 290/μl. This patient had received additional chemotherapy after count recovery and prior to discharge, and was readmitted with Clostridium tertium bacteremia.

Conclusion

These results suggest that a post-nadir ANC > 100/μl is a safe threshold value for empiric antibiotic discontinuation and discharge home.