Abstract
Background
Poor and delayed microbiological documentation of episodes of febrile neutropenia (EFN) deserves improvement. We assessed the impact of a new blood culture (BC) sampling protocol to optimize the diagnosis of bloodstream infection during EFN, compared with standard of care protocol.
Methods
This pre/post intervention included patients who presented an EFN in a pediatric hematology-oncology center. Data were compared between 1-year periods P1 (110 EFN, 53 patients) and P2 (124 EFN, 53 patients). Pre-intervention settings were 1−2 mL of blood cultured per BC set and several samplings over days (multisampling strategy) during period P1 vs. one unique early sampling of a large volume of blood (0.5–60 mL) depending on patient weight during period P2 (single-sampling weight-adapted strategy). Microbial detection and time-to-diagnosis were evaluated.
Results
Seventeen EFNs were microbiologically documented in P1 (15.5%) and 26 in P2 (21%). The rate of positive BC sets increased during P2 (10.4% vs. 5.8%). All cases of bacteremia were documented by BC drawn during the first 4 days of fever, and during P2 by samples obtained on the first day of fever.
Conclusions
Bacteremia detection was improved. This proof-of-concept study shows benefits of combining the single-sampling strategy with large weight-adapted blood sampling strategy during EFN.
Impact
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Combination of single-sampling and weight-adapted blood culture strategies showed benefits in the documentation of bloodstream infections during febrile neutropenia.
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Bacteremia detection was improved in this preliminary study and this warrants further evaluation in the overall pediatric population.
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We observed no adverse effects associated with the new strategy while overall blood sparing was improved and handling of intravascular devices was reduced.
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The good tolerance of the blood sampling suggests that the recommended 1% volume limitation in children could be reconsidered.
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A similar evaluation is justified in the overall pediatric population suspected for bloodstream infection.
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Acknowledgements
This work was supported by the University Hospital of Montpellier.
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B.L., H.M. and N.S. conceptualized and designed the study, carried out the analyses, and drafted reviewed and revised the manuscript. S.D. collected the data, carried out the analyses, drafted the initial manuscript, and critically reviewed the manuscript. L.S. and S.H. conceptualized and designed the study, collected the data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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This study is an observational study that fell within routine practice with nonadditional diagnostic and monitoring procedures applied to the patient. During period 1 data derived from routine clinical care were retrospectively analyzed. During period 2, the unit switched its blood culture sampling strategy; data were prospectively collected but strictly corresponded to the routine care of the patients with no additional intervention. Thus, research concerns only data derived from the routine care of the patient. In this context, the Ethics Advisory Committee waived the requirement to obtain a signed informed consent document, as accepted for research procedures involving no risk for the patient.
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Lamy, B., Dutron, S., Haouy, S. et al. Optimized blood culture strategy to document febrile neutropenia. Pediatr Res 89, 1109–1116 (2021). https://doi.org/10.1038/s41390-020-1086-0
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DOI: https://doi.org/10.1038/s41390-020-1086-0
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