Document Type
Article
Publication Date
3-2025
Identifier
DOI: 10.1002/pbc.31532
Abstract
INTRODUCTION: While clinical practice guidelines (CPGs) for pediatric oncology infection prophylaxis and management exist, few data describe actual management occurring at pediatric oncology centers.
METHODS: An electronic survey querying infection management practices in nontransplant pediatric oncology patients was iteratively created by the Children's Oncology Group (COG) Cancer Control and Supportive Care Infectious Diseases Subcommittee and sent to leaders at all COG institutions, limiting each site to one response to represent their institution.
RESULTS: The response rate was 57% (129/227 institutions). Many sites reported utilizing COG-endorsed CPGs for antibacterial (76%) and antifungal prophylaxis (74%), and fever and neutropenia (FN, 64%). Most institutions reported using antimicrobial prophylaxis for patients with acute myeloid leukemia (88% antibacterial, 100% antifungal) and relapsed acute lymphoblastic leukemia (82% antibacterial, 95% antifungal). Definitions of fever, phagocyte recovery, and antibiotic duration in febrile patients varied. Most institutions administer empiric broad-spectrum antibiotics for nonneutropenic fever, although 14% reported withholding antibiotics based on initial clinical status or risk stratification tools. Most respondents reported (70%) admitting FN patients for at least 48 h, however 15% have low-risk FN protocols allowing outpatient management. FN patients remain admitted on antibiotics through count recovery in 50% of institutions, whereas the others employed various early discharge/early antibiotic discontinuation strategies.
CONCLUSIONS: There is often consistency but also substantial variability in reported antimicrobial prophylaxis strategies and management of patients with fever and represents an opportunity for implementation studies to standardize application of CPG recommendations and randomized trials to advance evidence where knowledge gaps exist.
Journal Title
Pediatric blood & cancer
Volume
72
Issue
3
First Page
31532
Last Page
31532
MeSH Keywords
Humans; Child; Neoplasms; Surveys and Questionnaires; Practice Guidelines as Topic; Female; Male; Anti-Bacterial Agents; Antibiotic Prophylaxis
PubMed ID
39780366
Keywords
Children's Oncology Group; febrile neutropenia; fungal prophylaxis; infectious complications; pediatric oncology; supportive care
Recommended Citation
Slatnick LR, Hoogstra D, Fisher BT, et al. Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions. Pediatr Blood Cancer. 2025;72(3):e31532. doi:10.1002/pbc.31532
Comments
Grants and funding
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Publisher's Link: https://onlinelibrary.wiley.com/doi/10.1002/pbc.31532