TY - JOUR
T1 - Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer
AU - Zhao, Zhiguo
AU - Patel, Pratik A.
AU - Slatnick, Leonora
AU - Sitthi-Amorn, Anna
AU - Bielamowicz, Kevin J.
AU - Nunez, Farranaz A.
AU - Walsh, Alexandria M.
AU - Hess, Jennifer
AU - Rossoff, Jenna
AU - Elgarten, Caitlin
AU - Myers, Regina
AU - Saab, Raya
AU - Basbous, Maya
AU - Mccormick, Meghan
AU - Aftandilian, Catherine
AU - Richards, Rebecca
AU - Nessle, C. Nathan
AU - Tribble, Alison C.
AU - Sheth Bhutada, Jessica K.
AU - Coven, Scott L.
AU - Runco, Daniel
AU - Wilkes, Jennifer
AU - Gurunathan, Arun
AU - Guinipero, Terri
AU - Belsky, Jennifer A.
AU - Lee, Karen
AU - Wong, Victor
AU - Malhotra, Megha
AU - Armstrong, Amy
AU - Jerkins, Lauren P.
AU - Cross, Shane J.
AU - Fisher, Lyndsay
AU - Stein, Madison T.
AU - Wu, Natalie L.
AU - Yi, Troy
AU - Orgel, Etan
AU - Haeusler, Gabrielle M.
AU - Wolf, Joshua
AU - Demedis, Jenna M.
AU - Miller, Tamara P.
AU - Esbenshade, Adam J.
N1 - Publisher Copyright:
© 2023 American Society of Clinical Oncology.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85186542583&partnerID=8YFLogxK
U2 - 10.1200/JCO.23.01814
DO - 10.1200/JCO.23.01814
M3 - Article
C2 - 38060973
AN - SCOPUS:85186542583
SN - 0732-183X
VL - 42
SP - 832
EP - 841
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 7
ER -