Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer
PURPOSE: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation.
MATERIALS AND METHODS: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration.
RESULTS: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics.
CONCLUSION: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Journal of clinical oncology : official journal of the American Society of Clinical Oncology - 42(2024), 7 vom: 01. März, Seite 832-841 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhao, Zhiguo [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 29.02.2024 Date Revised 03.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1200/JCO.23.01814 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365518654 |
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| 041 | |a eng | ||
| 100 | 1 | |a Zhao, Zhiguo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 29.02.2024 | ||
| 500 | |a Date Revised 03.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation | ||
| 520 | |a MATERIALS AND METHODS: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration | ||
| 520 | |a RESULTS: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics | ||
| 520 | |a CONCLUSION: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Patel, Pratik A |e verfasserin |4 aut | |
| 700 | 1 | |a Slatnick, Leonora |e verfasserin |4 aut | |
| 700 | 1 | |a Sitthi-Amorn, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Bielamowicz, Kevin J |e verfasserin |4 aut | |
| 700 | 1 | |a Nunez, Farranaz A |e verfasserin |4 aut | |
| 700 | 1 | |a Walsh, Alexandria M |e verfasserin |4 aut | |
| 700 | 1 | |a Hess, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Rossoff, Jenna |e verfasserin |4 aut | |
| 700 | 1 | |a Elgarten, Caitlin |e verfasserin |4 aut | |
| 700 | 1 | |a Myers, Regina |e verfasserin |4 aut | |
| 700 | 1 | |a Saab, Raya |e verfasserin |4 aut | |
| 700 | 1 | |a Basbous, Maya |e verfasserin |4 aut | |
| 700 | 1 | |a Mccormick, Meghan |e verfasserin |4 aut | |
| 700 | 1 | |a Aftandilian, Catherine |e verfasserin |4 aut | |
| 700 | 1 | |a Richards, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Nessle, C Nathan |e verfasserin |4 aut | |
| 700 | 1 | |a Tribble, Alison C |e verfasserin |4 aut | |
| 700 | 1 | |a Sheth Bhutada, Jessica K |e verfasserin |4 aut | |
| 700 | 1 | |a Coven, Scott L |e verfasserin |4 aut | |
| 700 | 1 | |a Runco, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Wilkes, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Gurunathan, Arun |e verfasserin |4 aut | |
| 700 | 1 | |a Guinipero, Terri |e verfasserin |4 aut | |
| 700 | 1 | |a Belsky, Jennifer A |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Karen |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Victor |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Megha |e verfasserin |4 aut | |
| 700 | 1 | |a Armstrong, Amy |e verfasserin |4 aut | |
| 700 | 1 | |a Jerkins, Lauren P |e verfasserin |4 aut | |
| 700 | 1 | |a Cross, Shane J |e verfasserin |4 aut | |
| 700 | 1 | |a Fisher, Lyndsay |e verfasserin |4 aut | |
| 700 | 1 | |a Stein, Madison T |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Natalie L |e verfasserin |4 aut | |
| 700 | 1 | |a Yi, Troy |e verfasserin |4 aut | |
| 700 | 1 | |a Orgel, Etan |e verfasserin |4 aut | |
| 700 | 1 | |a Haeusler, Gabrielle M |e verfasserin |4 aut | |
| 700 | 1 | |a Wolf, Joshua |e verfasserin |4 aut | |
| 700 | 1 | |a Demedis, Jenna M |e verfasserin |4 aut | |
| 700 | 1 | |a Miller, Tamara P |e verfasserin |4 aut | |
| 700 | 1 | |a Esbenshade, Adam J |e verfasserin |4 aut | |
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