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Febrile neutropenia is a common infectious complication in children and adolescents receiving chemotherapy for cancer, requiring immediate hospitalisation and empirical antibacterial therapy. The risk for a severe infection increases with lower neutrophil counts, but other factors such as underlying malignancy, remission state or the genetic background might also impact on the risk and severity of infection. Initial antibacterial treatment as well as modification and cessation of therapy depends on clinical performance, microbiological findings and haematological recovery. Although paediatric specific guidelines have been developed in the last decade, a number of questions are still unsolved. This article gives an overview on diagnostics and management of paediatric patients presenting with febrile neutropenia, on research gaps and will speculate on future perspective.
Background: Available data on the incidence and outcome of invasive fungal diseases (IFD) in children with hematological malignancies or after allogeneic hematopoietic stem cell transplantation (HSCT) are mostly based on monocenter, retrospective studies or on studies performed prior to the availability of newer triazoles or echinocandins.
Procedure: We prospectively collected clinical data on incidence, diagnostic procedures, management and outcome of IFD in children treated for hematological malignancies or undergoing HSCT in three major European pediatric cancer centers.
Results: A total of 304 children (median age 6.0 years) who underwent 360 therapies (211 chemotherapy treatments, 138 allogeneic HSCTs and/or 11 investigational chemotherapeutic treatments) were included in the analysis. Nineteen children developed proven/probable IFD, mostly due to Aspergillus (n = 10) and Candida spp. (n = 5), respectively. In patients receiving chemotherapy, 11 IFDs occurred, all during induction or re-induction therapy. None of these patients died due to IFD, whereas IFD was lethal in 3 of the 8 HSCT recipients with IFD. Significant differences among centers were observed with regard to the use of imaging diagnostics and the choice, initiation and duration of antifungal prophylaxis.
Conclusion: This prospective multicenter study provides information on the current incidence and outcome of IFD in the real life setting. Practice variation between the centers may help to ultimately improve antifungal management in children at highest risk for IFDs.