Peripheral Blood Cultures in Pediatric Cancer Patients: Redundant or Useful?

Peripheral blood cultures may cause unnecessary discomfort and delays in clinical care for pediatric cancer patients, according to a recent study published in Jco Oncology Practice. Researchers at the Baylor College of Medicine in Houston, Texas, examined the utility and clinical impact of peripheral blood cultures in pediatric hematology/oncology patients with fever. The study found that peripheral cultures had minimal overall impact on bloodstream infection diagnosis and central line-associated infection removal.

Key Takeaways:

• The study reviewed blood cultures for acute fever in pediatric hematology/oncology patients from January 1, 2020, through December 31, 2021, and found that peripheral cultures had minimal overall impact on bloodstream infection diagnosis and central line-associated infection removal.
• Peripheral cultures were used in only 25% of paired culture events, and a noncontaminant pathogen was isolated from peripheral cultures in only 1.1% of paired culture events.
• The differential time to positivity (DTP) criterion suggested central line-associated infection in 15 patients, but central line removal occurred in only 7 cases, and DTP was the sole criterion for removal only once.
• The study concluded that when a central line is present, peripheral blood cultures were too infrequently useful to require as a standard of care.
• The study's findings support the conditional recommendation of using paired central and peripheral blood cultures only for pediatric hematology/oncology and hematopoietic stem-cell transplant patients.

Statistics:

• 625 paired culture events were reviewed, with peripheral cultures used in only 1.1% of events.
• 25 central lines were removed due to specific pathogens, septic shock, or persistent culture positivity despite appropriate antibiotics.
• 15 patients had a DTP criterion suggesting central line-associated infection, but central line removal occurred in only 7 cases.

Sources:

• Interdisciplinary Collaborative Care Guidelines for Adults with Cancer Committee of the Oncologic Nursing Society. (2022). Cancer Nursing Practice in the Hospital. Clinical Journal of Oncology Nursing, 26(3), 451–461. doi: 10.1188/22.CJON.451-461
• APC. (2022). AACP Academic Pharmacotherapy Newsletter, 37(2), 8–10.
• Thomas, R. (2023). What Are The Key Challenges Facing Healthcare Diagnoses? Forbes. https://www.forbes.com/sites/robertthomas/2023/01/13/what-are-the-key-challenges-facing-healthcare-diagnoses/?sh=51de266737ee