Introduction: Pulmonary infections are not uncommon in patients with febrile neutropenia. Physicians have agreed to perform a chest X-ray (CXR) for all febrile neutropenic patients presenting with respiratory signs/symptoms. Nevertheless, they were divided into two groups when it came to asymptomatic febrile neutropenic patients (i.e. without respiratory signs/symptoms). A superior alternative to CXR is Computed Tomography (CT). CT, in comparison to CXR, was shown to have better sensitivity in detecting pulmonary foci. The aim of our study is to compare the diagnostic performance of CT and CXR in febrile neutropenic patients presenting to the emergency department, regardless of their clinical presentation. We are also interested in the predictors of pneumonia on chest imaging. Methodology: This is a retrospective cohort study conducted on febrile neutropenic adult cancer patients presenting to the emergency department of the American University of Beirut Medical Center. Results: 11.4% of 263 patients had pneumonia although 27.7% had respiratory signs/symptoms. 17.1% of those who were symptomatic and did a CXR were found to have pneumonia. 41.7% of those who were symptomatic and did a CT were found to have pneumonia. 30% had negative findings on CXR but pneumonia on CT. Conclusion: Patients with positive findings of pneumonia on chest imaging mainly had solid tumors, profound neutropenia, a higher CCI and a longer LOS. The presence of respiratory signs is the main predictor of positive pneumonia on chest imaging. CT is superior to CXR in detecting pulmonary foci in the population studied.

Many guidelines recommend a peripheral and central blood culture in febrile children with cancer, although data on the utility of the former are scarce. We aimed to report the prevalence and predictors of bacteremia in this cohort, and the utility of a peripheral blood culture in identifying missed bacterial infections. This was a single-center, retrospective study of febrile children with cancer. Between 2014 and 2018, we compared the group with at least one positive blood culture to the group without. We identified 342 unique febrile visits with a mean age of 7.6 years. Fifteen (4%) had bacteremia: 1 only peripheral, 11 only central, 3 both peripheral and central. The odds of bacteremia increased with reinduction chemotherapy (adjusted odds ratio [aOR] = 4.68 [1.13-19.42]) and decreased in children older than 3 years (aOR = 0.27 [0.09-0.80]). In conclusion, our rates of bacteremia were low and the utility of peripheral blood cultures was limited.