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. 2024 Mar 1;42(7):832-841.
doi: 10.1200/JCO.23.01814. Epub 2023 Dec 7.

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

Zhiguo Zhao  1 , Pratik A Patel  2 , Leonora Slatnick  3 , Anna Sitthi-Amorn  4 , Kevin J Bielamowicz  5 , Farranaz A Nunez  5 , Alexandria M Walsh  6 , Jennifer Hess  6 , Jenna Rossoff  7 , Caitlin Elgarten  8 , Regina Myers  8 , Raya Saab  9 , Maya Basbous  9 , Meghan Mccormick  10 , Catherine Aftandilian  11 , Rebecca Richards  11 , C Nathan Nessle  12 , Alison C Tribble  13 , Jessica K Sheth Bhutada  14   15 , Scott L Coven  16 , Daniel Runco  16 , Jennifer Wilkes  17 , Arun Gurunathan  17 , Terri Guinipero  18 , Jennifer A Belsky  16 , Karen Lee  19 , Victor Wong  19 , Megha Malhotra  20 , Amy Armstrong  20 , Lauren P Jerkins  4 , Shane J Cross  21 , Lyndsay Fisher  5 , Madison T Stein  8 , Natalie L Wu  17 , Troy Yi  17 , Etan Orgel  14   15 , Gabrielle M Haeusler  22 , Joshua Wolf  23 , Jenna M Demedis  3 , Tamara P Miller  2 , Adam J Esbenshade  24
Affiliations

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

Zhiguo Zhao et al. J Clin Oncol. .

Erratum in

Abstract

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.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1.
FIG 1.
(A) Calibration plot and (B) receiver operating curve of the EsVan2b model applied to the validation cohort. BSI, bloodstream infection; EsVan, Esbenshade Vanderbilt; NPV, negative predictive value; PPV, positive predictive value; ROC, receiver operator characteristic.
FIG 2.
FIG 2.
Observed BSI by predicted risk groups for the EsVan2b model. BSI, bloodstream infection; EsVan, Esbenshade Vanderbilt.
FIG 3.
FIG 3.
Diagram of the study cohort patient outcome and management. BSI, bloodstream infection; ED, emergency department; ICU, intensive care unit.
See this image and copyright information in PMC

References

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