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Predicting bacterial infections among pediatric cancer patients with febrile neutropenia: External validation of the PICNICC model
Author(s) -
Ojha Rohit P.,
Asdahl Peter H.,
Steyerberg Ewout W.,
Schroeder Henrik
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26935
Subject(s) - medicine , febrile neutropenia , neutropenia , pediatric cancer , receiver operating characteristic , pediatric oncology , antibiotic stewardship , confidence interval , antibiotics , cancer , intensive care medicine , pediatrics , chemotherapy , antibiotic resistance , microbiology and biotechnology , biology
The Predicting Infectious Complications in Neutropenic Children and Young People with Cancer (PICNICC) model was recently developed for antibiotic stewardship among pediatric cancer patients, but limited information is available about its clinical usefulness. We aimed to assess the performance of the PICNICC model for predicting microbiologically documented bacterial infections among pediatric cancer patients with febrile neutropenia. Materials and methods We used data for febrile neutropenia episodes at a pediatric cancer center in Aarhus, Denmark between 2000 and 2016. We assessed the area under the receiver operating characteristic curve (AUC), calibration, and clinical usefulness (i.e., net benefit). We also recalibrated the model using statistical updating methods. Results We observed 306 microbiologically documented bacterial infections among 1,892 episodes of febrile neutropenia. The AUC of the model was 0.73 (95% confidence limits [CL]: 0.71–0.75). The calibration intercept (calibration‐in‐the‐large) was −0.69 (95% CL: −0.86 to −0.51) and the slope was 0.77 (95% CL: 0.65–0.89). Modest net benefit was observed at a decision threshold of 5%. Recalibration improved calibration but did not improve net benefit. Conclusions The PICNICC model has potential for reducing unnecessary antibiotic exposure for pediatric cancer patients with febrile neutropenia, but continued validation and refinement is necessary to optimize clinical usefulness.