Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation

Abstract

Background Bacteremia and other invasive bacterial infections are common among children with cancer receiving intensive chemotherapy and in pediatric recipients of hematopoietic stem cell transplantation (HSCT). Systemic antibacterial prophylaxis is one approach that can be used to reduce the risk of these infections. Our purpose was to develop a clinical practice guideline (CPG) for systemic antibacterial prophylaxis administration in pediatric patients with cancer and those undergoing HSCT. Methods An international and multidisciplinary panel was convened with representation from pediatric hematology/oncology and HSCT, pediatric infectious diseases (including antibiotic stewardship), nursing, pharmacy, a patient advocate, and a CPG methodologist. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to generate recommendations based on the results of a systematic review of the literature. Results The systematic review identified 114 eligible randomized trials of antibiotic prophylaxis. The panel made a weak recommendation for systemic antibacterial prophylaxis for children receiving intensive chemotherapy for acute myeloid leukemia and relapsed acute lymphoblastic leukemia (ALL). Weak recommendations against the routine use of systemic antibacterial prophylaxis were made for children undergoing induction chemotherapy for ALL, autologous HSCT and allogeneic HSCT. A strong recommendation against its routine use was made for children whose therapy is not expected to result in prolonged severe neutropenia. If used, prophylaxis with levofloxacin was recommended during severe neutropenia. Conclusions We present a CPG for systemic antibacterial prophylaxis administration in pediatric cancer and HSCT patients. Future research should evaluate the long-term effectiveness and adverse effects of prophylaxis.

Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997–2017)

“…This will likely include indwelling CVC care, improved skin and oral care, and acute and chronic GVHD prophylaxis and treatment to be continued even after hospital discharge. There are currently insufficient data to support routine antibacterial prophylaxis for children undergoing HSCT, but this remains an active area of research [ 54 ]. Finally, the rising prevalence of VRE in this cohort is particularly worrisome.…”

Antimicrobial Prophylaxis and Modifications of the Gut Microbiota in Children with Cancer

“…The severity of bacterial infections during periods of neutropenia in children with cancer makes essential the appropriate use of broad-spectrum antibiotics to resolve this kind of complication and to reduce associated morbidity and mortality. Many different approaches have been discussed in recent years, particularly concerning the correct classes of antibiotics to use on these occasions and whether to prevent infectious complications with systemic antibiotic prophylaxis or to treat them when microbiologically documented [ 12 , 13 ]. In the current literature, there is a lack of clinical guidelines concerning the routine use of antibacterial prophylaxis.…”

“…In the current literature, there is a lack of clinical guidelines concerning the routine use of antibacterial prophylaxis. A recent study by Lehrnbecher et al reviewed the works on this argument to develop a guideline for the administration of antibiotic prophylaxis in pediatric clinical practice, proving that there are not enough studies supporting the routine use of antibiotics in children with cancer or HCT recipients because the benefits of prophylaxis are balanced by its unknown and potential impacts and resistance [ 12 ]. However, antimicrobial prophylaxis for neutropenic patients undergoing cytotoxic therapy reduces mortality, as supported by a meta-analysis published by Gafter-Gvili et al [ 13 ], showing the importance of appropriate administration and selection of the correct class of antibiotic.…”

Development and utility assessment of a machine learning bloodstream infection classifier in pediatric patients receiving cancer treatments

“…Patients without cancer undergoing hematopoietic stem cell transplantation (HSCT) are also at risk for life-threatening BSI [6]. Identifying the risk of BSI is important as those at lower risk may benefit from less intensive interventions such as outpatient management of fever, while those at higher risk may benefit from more intensive interventions such as broader empiric antibiotics or antibacterial prophylaxis [7,8].…”