Infection and Drug Resistance (Mar 2021)
Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children
Abstract
Jessica E Morgan,1,2 Bob Phillips,1,2 Gabrielle M Haeusler,3– 6 Julia C Chisholm7 1Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, UK; 2Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK; 3NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, 3010, Australia; 4Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, 3010, Australia; 5Infection Diseases Unit, Department of General Medicine, Royal Children’s Hospital, Parkville, Victoria, 3168, Australia; 6Murdoch Children’s Research Institute, Parkville, Victoria, 3052, Australia; 7Royal Marsden Hospital and Institute of Cancer Research, Sutton, SM2 5PT, UKCorrespondence: Jessica E MorganCentre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, UKTel +44 01904 321082Email [email protected]: Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating de-escalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.Keywords: paediatric, febrile neutropenia, antimicrobials
