Narrative Review and Diagnostic Performance Assessment of Paired Blood Cultures in Children with Cancer and Febrile Neutropenia: An Analysis of Four Studies

Abstract

Children receiving cancer treatment face a heightened risk of bloodstream infections, posing challenges in care. Accurate diagnosis is crucial, and paired blood cultures (BC) from central venous catheter (CVC) and peripheral vein (PV) are a promising diagnostic approach. This review assesses the diagnostic accuracy and clinical utility of pediatric paired BC in children with cancer. A PubMed search (2003-2023) yielded 1042 titles; four articles meeting inclusion criteria were included. Studies on diagnostic accuracy or clinical utility of pediatric paired BC in ages 0-18 were reviewed by two independent assessors. Data extraction covered study characteristics, demographics, and diagnostic parameters. Observing 825 positive paired BC with a 23.5% false-positive rate, PV exclusively detected bacteremia in 22.7%, while CVC culture exclusively detected it in 54.7%. Both methods detected bacteremia in 54.0%. Variable sensitivity, specificity, PPV, and NPV across studies necessitate nuanced interpretation. PV showed higher sensitivity, while CVC exhibited higher specificity. Method choice should align with clinical context, urgency, and potential consequences. False positives, particularly with CVC, underscore the need for cautious clinical decision-making. Personalized approaches balancing clinical and diagnostic considerations are essential. Collecting paired samples aids in avoiding false positives, reducing unnecessary interventions, but may involve causing pain.