Background: The collection of blood cultures (BC) is key for guiding antimicrobial therapy in children with febrile neutropenia (FN), more than 90% have central venous catheters (CVC). There is no consensus on the need for peripheral BC over central BC in this population. The aim of this study was to determine the contribution of peripheral BC over central BC in the diagnosis of bloodstream infections in children with FN. Methods: Descriptive, retrospective study, episodes of FN recorded prospectively in 6 hospitals in Santiago, Chile, from 2016 to 2021. Central and peripheral BC were drawn upon admission. All episodes with at least one (+) BC were allocated to one of these groups: consistent (+) BC, inconsistent (+) BC, only CVC (+) BC and only peripheral (+) BC. The volume of the samples was recorded. Results: The analysis included 241 episodes of FN with at least one (+) BC. The median age was 7.2 years, 51% were female, 84% had hematological cancer and 98% had episodes of high-risk FN. Of a total of 241 episodes, 135 (56%) had consistent (+) BC, 13 (5%) had inconsistent (+) BC, 35 (15%) had only CVC (+) BC and 58 (24%) had only peripheral (+) BC. There were no significant differences in the volume of the samples between central and peripheral BC. Conclusions: The proportion of bloodstream infections detected only through peripheral BC was 24%, higher than previously reported, not due to sample volume. We recommend obtaining peripheral as well CVC BC in children with FN.

Invasive fungal disease (IFD) is one of the leading causes of morbidity and mortality in immunocompromised pediatric patients. This is a multicenter prospective cohort study with a nested retrospective analysis aimed at identifying risk factors for IFD in immunocompromised children with cancer and episodes of persistent high-risk febrile neutropenia (HRFN). One hundred and seventy-four episodes of persistent HRFN were analyzed, of which 34 (19.5%) were confirmed as IFD, 52.9% were caused by filamentous fungi, and 47.1% by yeasts. Logistic regression and survival analyses identified the following significant risk factors for IFD: male sex (OR 4.04), adolescence (OR 4.65), C-reactive protein ≥ 90 mg/L at admission (OR 3.13), and transfer to a critical care unit (OR 10.73). The predictive model demonstrated strong discriminatory capacity (AUC 0.84), with 79.4% sensitivity and 82.1% specificity. These findings highlight that adolescents, particularly males with severe clinical conditions and elevated inflammatory markers, are at the highest risk for IFD during episodes of HRFN. The proposed risk factor-based model may support early risk stratification and guide targeted antifungal prophylaxis or therapy, potentially improving outcomes in this population. Validation an external cohort is required to confirm these results and optimize clinical applicability.

Background: Febrile neutropenia (FN) is one of the most frequent complications of antineoplastic treatment in patients with cancer. Invasive bacterial infections and invasive fungal infections are a major cause of morbidity and mortality in this population, along with respiratory viral infections, which are increasingly recognized in children with FN episodes. Objectives: This study aimed to compare the clinical outcome of children with persistent high-risk FN (HRFN) that have an abnormal chest computed tomography (CT) versus those with normal chest CT or in which chest CT was not indicated, and to evaluate the microbiologic etiology and pulmonary tomographic findings in this population. Methods: Patients with persistent HRFN were prospectively enrolled between 2016 and 2021 and classified into 2 groups: children with persistent HRFN that had an abnormal chest CT and children that had a normal chest CT or in which chest CT was not clinically indicated. We compared the clinical outcome of the patients of the 2 groups. Children with abnormal chest CT underwent a microbiologic and molecular study to evaluate the etiology of the pulmonary compromise. After discharge, all children with persistent HRFN that had an abnormal chest CT were evaluated by 2 groups of independent, blind investigators: 1 pediatric infectious disease specialist that classified the etiology of the pulmonary infiltrate as bacterial, fungal, viral or unknown etiology and 2 pediatric radiologists that classified each chest CT, as defined by the Fleischner Society. Results: We enrolled 176 children with persistent HRFN, of which 36 had abnormal chest CT. In 27/36 episodes (75%), the etiology was determined (12 bacterial, 8 viral and 7 fungal). Subjects with an abnormal chest CT had more days of fever, longer length of hospital stay, higher PICU admission, more use of mechanical ventilation, more oxygen requirement, longer periods of antibacterial and antifungal therapy. Chest CT showed no statistically significant differences when findings were compared by etiology of the episodes. Conclusions: Our results strongly support that abnormal findings on chest CT in children with persistent HRFN should be interpreted as a predictor of poor clinical outcome, as not as a marker of etiology.

Background: Around 30% of survivors of invasive meningococcal disease (IMD) may develop long-term sequelae; data from Latin America remain scarce. This study aimed to estimate the proportion of long-term sequelae in pediatric IMD survivors and associated factors. Methods: A retrospective cohort study with cross-sectional outcome evaluation included children diagnosed with IMD (2009–2019) in 2 hospitals in Santiago, Chile. Between October 2022 and April 2023, 40 IMD survivors and 42 age- and sex-matched children without IMD or central nervous system infection underwent standardized physical, neurocognitive, audiologic and functional assessments conducted independently. Prevalence ratio (PR) and adjusted PR (aPR) were estimated with modified Poisson regression with standard errors. Results: Median ages were 10 (interquartile range [IQR] 9–13) and 11 (IQR 9–14) years in the exposed and unexposed groups; 70% and 64.3% were male. Sequelae occurred in 70% of exposed; the corresponding clinical findings were present in 16.7% of unexposed children (PR, 4.20; 95% confidence interval [CI]: 2.07–8.51). Neurologic (55%), dermatologic (25.0%) and hearing (20.5%) sequelae predominated. This association remained significant after adjusting for age, sex, caregiver education and socioeconomic status (aPR, 3.75; 95% CI: 1.83–7.69). Children with sequelae had a lower quality of life than those without sequelae (62% and 8%, P = 0.004). Conclusion: Pediatric survivors of IMD in Chile face a high burden of long-term sequelae. Sustained multidisciplinary follow-up and preventive strategies, including vaccination, are essential to reduce disability and improve quality of life.

Background/Objectives: The objective of this study is to evaluate the efficacy and safety of maintaining antimicrobial (AM) therapy or adjusting AM therapy during episodes of febrile neutropenia (FN) catalogued as a fever of unknown origin (FUO) in children with cancer. Methods: This is a prospective, multicenter, noninferiority, randomized study, approved by ethics committee, in children with episodes of FN in eight hospitals in Chile. Microbiological and molecular samples were drawn at admission. Patients with FUO (negative bacterial and viral study with no clinical focus suggesting infection) and favorable evolution during the first 48–72 h of AM therapy were randomized 1:1 to maintain or adjust treatment, reducing the number and spectrum of AMs. The primary endpoint was the percentage of episodes with an uneventful resolution; the secondary endpoints were the re-adjustment of AM therapy, days of fever/hospitalization/AM therapy, days of vancomycin and meropenem per 1000 days of neutropenia, number of AMs after randomization, pediatric intensive care unit (PICU) admission, sepsis, and death. Results: A total of 266 of 939 FN episodes recruited between March 2021 and January 2024 were catalogued as FUO, of which 231 had a favorable evolution at 48–72 h and were randomized, 111 to maintain and 120 to adjust AM therapy. Both groups presented the same percentage of uneventful resolution, with 106 (96%) in the group that maintain AM therapy and 114 (95%) in the adjusted group (p = 1.00); relative risk 1.01, (95%CI 0.95–1.06); absolute risk difference 0.01, (95%CI −0.05–0.06). Conclusions: The main finding of this study demonstrates that adjusting antimicrobial therapy appears safe in carefully selected FUO cases with a favorable early evolution, during episodes of FN catalogued as FUO in children with cancer. These findings open an opportunity to new AM stewardship strategies in this population, with a possible future impact on AM resistance.