• Andrea Mora-Capín, Jorge Lorente-Romero, Alicia Hernanz-Lobo, Arístides Rivas-García, Paula Vázquez-López, Paula Carrascosa-García, Andrés González-Hermosa, Juncal Mena-Huarte, María Amalia Pérez-Saez, Gemma Nadal, Irene García-de-Diego, Rafael Marañón-Pardillo, and Research Network of the Spanish Society of Pediatric Emergencies (RISeuP-SPERG).
• From the Hospital Gregorio Marañón, IisGM (Health Research Institute Gregorio Marañón), Madrid.
• Pediatr Emerg Care. 2022 Jul 1; 38 (7): e1378e1383e1378-e1383.

BackgroundThe main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs).MethodsThis is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected.ResultsOne hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/μL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI.ConclusionsNone of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/μL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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