Risk Factors in Children With Fever and Neutropenia
Authors: Wayne Rackoff, Philip Breitfeld, María Elena Santolaya
Journal: Journal of Clinical Oncology (2001)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.22.4270 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11709573 Risk Factors in Children With Fever and Neutropenia Wayne RackoffxWayne RackoffSearch for articles by this author , Philip BreitfeldxPhilip BreitfeldSearch for articles by this author María Elena SantolayaxMaría Elena SantolayaSearch for articles by this author Show More Janssen Research Foundation, Titusville, NJDuke University Medical Center, Durham, NCUniversity of Chile, Santiago, Chile https://doi.org/10.1200/JCO.2001.19.22.4270 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15112001In Reply:We thank Drs Rackoff and Breitfeld for adding new information that disputes our possible explanation as to why high fever and absolute monocyte count (AMC) were significant predictors of bacteremia in his study but not of invasive bacterial infection (IBI) in ours.1,2The article by Rackoff et al1 concluded that an AMC less than 100/mm3 and a temperature of ≥ 39°C were significantly associated with a higher risk for bacteremia. Our comments to this article were that the 95% confidence interval for the odds ratio comparing high-risk versus intermediate-risk groups in that study was wide (1.6 to 12.9) and that both variables in our study reached significance in the univariate but not multivariate analysis. We thus postulated that a similar solution could have occurred in the study by Rackoff et al if more children had been included.With the new information added by Rackoff’s group, although not yet available, and from the article by Klaassen et al,3 we tend to agree with Rackoff and Breitfeld that admission AMC less than 100/mm3 seems to be a good predictor for risk of bacteremia and significant bacterial infection as defined by both studies, although not for IBI as defined by us for our population. On the other hand, fever greater than 39°C seems to be less strongly associated with the risk for significant and invasive bacterial infection as reported by both Klaassen et al3 and our study.2 The variable may be associated with a risk factor for bacteremia, Rackoff’s end point. In this context, we also agree with Rackoff and Breitfeld that our models may be different because our primary outcome and some characteristics of the population differ significantly. Our model is more comparable to that used by Klaassen et al, considering that our outcome is risk for IBI and theirs is risk for “significant bacterial infection,” both of which included bacteriologically demonstrated as well as nondemonstrated, albeit probable bacterial infections. We must point out that when we considered only demonstrated IBI, defined as a positive bacterial culture obtained from a usually sterile site (eg, blood, indwelling catheter, urine, and CSF), neither monocyte count nor temperature was an independent risk factor for IBI.Finally, we stress the concept that predictive models have to be prospectively evaluated in populations that share characteristics with the study population. In our common aim to consider a selective approach for febrile neutropenic children, only this type of evaluation will confirm if our models are useful for clinical practice.1. Rackoff WR, Gonin R, Robinson C, et al: Predicting the risk of bacteremia in children with fever and neutropenia. J Clin Oncol 14:: 919,1996-924, Link, Google Scholar2. Santolaya ME, Alvarez AM, Becker A, et al: Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol 19:: 3415,2001-3421, Link, Google Scholar3. Klaassen RJ, Goodman TR, Pham B, et al: ‘Low-risk‘ prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol 18:: 1012,2000-1019, Link, Google Scholar