Assessing the Impact of Pandemic-Related Social Distancing Mandates on Bloodstream Infection Rates in Children With Chemotherapy-Induced Febrile Neutropenia

Children with severe neutropenia are advised to avoid activities and public spaces where they may be exposed to potential sources of infection, due to the risk of neutropenic fever, an oncologic emergency. The influence of exposure to environmental infectious disease risk factors (IDRFs) on the incidence of bacteremia has been difficult to study. Lockdowns enforced during the COVID-19 pandemic resulted in widespread social distancing and were associated with reduced opportunities for exposure to such environmental risk factors. We performed a retrospective chart review to compare the incidence of fever and bloodstream infection in patients with chemotherapy-induced neutropenia before (March 15, 2019 to March 14, 2020) and during the COVID-19 pandemic (March 15, 2020 to March 14, 2021). Before COVID-19, there were 219 episodes of neutropenia, 79 episodes with fever, and 12 episodes with bacteremia. During COVID-19, there were 236 episodes of neutropenia, 80 episodes with fever, and 13 episodes with bacteremia. In this small retrospective study, we did not observe a statistically significant difference in the incidence of either febrile neutropenia or febrile neutropenic bloodstream infection across 2 years with differing levels of exposure to environmental IDRFs (febrile neutropenia: IRR=0.89, P=0.38; bloodstream infection: IRR=1.01, P=0.99). Further multicenter studies are needed to better define the risks of exposure to potential environmental sources of infection, which may ultimately impact provider guidance for children with severe neutropenia.