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Children with unexpected isolated neutropenia at low risk of SBI

Clinical Question:
What is the risk of serious bacterial infection among children with unsuspected and isolated neutropenia without underlying risk factors?

Bottom Line:
The risk of a serious bacterial infection (SBI) among children with unsuspected and isolated neutropenia, but no underlying risk factors, is low (2.4%). (LOE = 2b)

Reference:
Melendez E, Harper MB. Risk of serious bacterial infection in isolated and unsuspected neutropenia. Acad Emerg Med 2010;17(2):163-67.

Study Design:
Cohort (retrospective)

Setting:
Emergency department

Synopsis:
These investigators reviewed medical records from all children, aged 0 to 21 years, presenting to an emergency department of a large children's hospital for a period of 8 consecutive years. Eligibility criteria included an identified absolute neutrophil count (ANC) of less than 1000 cells/uL, no underlying risk factors, including previous neutropenia, abnormal platelet or hemoglobin count, known immunodeficiency, suspected or known malignancies, implanted medical device susceptible to infection, congenital heart disease, or known genitourinary tract abnormalities. An SBI was defined as a positive bacterial culture from urine, blood, or cerebrospinal fluid. Chest x-ray for pneumonia was not included because of the difficulty delineating a bacterial versus viral cause. A total of 1888 patients met study criteria with a median age of 0.7 (0.1 - 5.2) years. Positive cultures occurred in a total of 31 patients for an overall 2.4% prevalence of SBI. The overall rate of SBI among infants younger than 3 months was similar to that expected among febrile infants (3.3%). The overall rate of SBI among children aged 3 months to 2 years and 2 years to 21 years of age was 2.0% and 1.5%, respectively. There was no increased risk of SBI in patients with an ANC less than 500 versus 501 to 1000. Absence of concomitant fever was associated with a reduced risk of SBI (0.4% afebrile vs 6.2% febrile).

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