Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer

• DOI: 10.1200/jco.23.01814
• Publication Date: 2023-12-07T21:00:53Z
• Authors: Zhiguo Zhao; Pratik A. Patel; Leonora Slatnick; Anna Sitthi-Amorn; Kevin J. Bielamowicz; Farranaz A. Nunez; Alexandra M. Walsh; Jennifer Hess; Jenna Rossoff; Caitlin Elgarten; Regina Myers; Raya Saab; Maya Basbous; Meghan Mccormick; Catherine Aftandi...; Rebecca Richards; C. Nathan Nessle; Alison C. Tribble; Jessica K. Sheth ...; Scott L. Coven; Daniel Runco; Jennifer Wilkes; Arun Gurunathan; Terri Guinipero; Jennifer A. Belsky; Karen Lee; Victor Wong; Megha Malhotra; Amy Armstrong; Lauren P. Jerkins; Shane J. Cross; Lyndsay Fisher; Madison T. Stein; Natalie L. Wu; Troy Yi; Etan Orgel; Gabrielle M. Haeu...; Joshua Wolf; Jenna M. Demedis; Tamara P. Miller; Adam J. Esbenshade
• Keywords: Bacteremia; Bloodstream infection; Central venous catheter; Fungemia

PURPOSE The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) this population and provide risk stratification to aid management, but have lacked prospective external validation. MATERIALS AND METHODS Episodes a central venous catheter ANC ≥500/µL occurring were prospectively collected from 18 academic medical centers. Variables included the EsVan 7-day clinical outcomes collected. Five versions applied data calculation C-statistics for both overall BSI rate high-risk organism (gram-negative Staphylococcus aureus BSI), as well model calibration. RESULTS In 2,565 evaluable episodes, was 4.7% (N = 120). Complications whole cohort rare, 1.1% 27) needing intensive care unit (ICU) by 7 days, all-cause mortality 0.2% 5), only one potential infection-related death. ranged 0.775 0.789 predicting BSI, improved accuracy (C-statistic 0.800-0.819). Initial empiric antibiotics withheld 14.9% no deaths or ICU admissions attributable not receiving antibiotics. CONCLUSION models, especially EsVan2b, perform very across multiple centers stratify episodes non-neutropenic cancer. Implementation routine screening risk-stratified could safely reduce unnecessary antibiotic use.