144 - Low Bacteremia Rates in Pediatric Febrile Neutropenia at Connecticut Children’s: A Five-Year Review Supporting Outpatient Management

Publication Number: 2138.144

Michael Isakoff, Connecticut Children's Medical Center, Hartford, CT, United States; Andrea Orsey, Connecticut Children's Medical Center, Hartford, CT, United States; Gazal Gulati, University of Massachusetts Medical School, Worcester, MA, United States; Natalie S. Bezler, Connecticut Children's Medical Center, Hartford, CT, United States

Background: Children receiving cytotoxic chemotherapy are at increased risk for infection, with fever often the first sign in neutropenic patients. Standard management involves urgent evaluation, empiric IV antibiotics, and hospitalization until fever resolution and neutrophil recovery. Several studies have proposed risk stratification to identify low-risk groups suitable for outpatient care.¹-⁴

Objective: This study reviews febrile neutropenia (FN) cases at Connecticut Children’s to inform development of new management guidelines for low-risk patients.

Design/Methods: Following IRB approval, a retrospective chart review was performed for patients with FN admitted between 2019–2023. Of 351 encounters, inclusion criteria were age 1–18 years and in remission for those with ALL. Exclusion criteria included AML diagnosis, hematopoietic stem cell transplant within 100 days, serious infection, or other conditions requiring admission (e.g., mucositis, dehydration). The final cohort of 259 patients was analyzed for bacteremia rates annually and cumulatively, and for timing of positive cultures.

Results: Among 259 eligible patients, the average bacteremia rate was 4.1% over five years. Year-specific rates were: 2019, 2.5% (2/80); 2020, 6.4% (2/31); 2021, 2.3% (1/42); 2022, 4.6% (3/65); and 2023, 4.9% (2/41). All positive blood cultures were identified from specimens drawn on the day of admission, with no subsequent positives during hospitalization.

Conclusion(s): The bacteremia rate among pediatric FN admissions at Connecticut Children’s was consistently below 5%, and all positive cultures occurred within the first 24 hours. These findings support consideration of a protocol allowing low-risk patients to transition to outpatient management after an initial 48-hour period of empiric IV antibiotics and clinical stability. Implementation of such a protocol could reduce hospital utilization and improve patient and family experience.⁵