title: A prospective multicenter study of microbiologically defined infections in pediatric cancer patients with fever and neutropenia: Swiss Pediatric Oncology Group 2003 fever and neutropenia study.
abstract: BACKGROUND
  Fever and neutropenia (FN) often complicate anticancer treatment and can be caused by potentially fatal infections. Knowledge of pathogen distribution is paramount for optimal patient management.
  
  
  METHODS
  Microbiologically defined infections (MDI) in pediatric cancer patients presenting with FN by nonmyeloablative chemotherapy enrolled in a prospective multicenter study were analyzed. Effectiveness of empiric antibiotic therapy in FN episodes with bacteremia was assessed taking into consideration recently published treatment guidelines for pediatric patients with FN.
  
  
  RESULTS
  MDI were identified in a minority (22%) of pediatric cancer patients with FN. In patients with, compared with patients without MDI, fever [median, 5 (interquartile range: 3-8) vs. 2 (interquartile range: 1-3) days, P < 0.001] and hospitalization [10 (6-14) vs. 5 (3-8) days, P < 0.001] lasted longer, transfer to the intensive care unit was more likely [13 of 95 (14%) vs. 7 of 346 (2.0%), P < 0.001], and antibiotics were given longer [10 (7-14) vs. 5 (4-7) days, P < 0.001]. Empiric antibiotic therapy in FN episodes with bacteremia was highly effective if not only intrinsic and reported antimicrobial susceptibilities were considered but also the purposeful omission of coverage for coagulase-negative staphylococci and enterococci was taken into account [81% (95% confidence interval: 68-90) vs. 96.6% (95% confidence interval: 87-99.4), P = 0.004].
  
  
  CONCLUSIONS
  MDI were identified in a minority of FN episodes but they significantly affected management and the clinical course of pediatric cancer patients. Compliance with published guidelines was associated with effectiveness of empiric antibiotic therapy in FN episodes with bacteremia.
authors.affiliation: From the *Department of Pediatrics; †Institute for Infectious Diseases, University of Bern, Bern, Switzerland; ‡Division of Pediatric Oncology, University Children's Hospital, Freiburg, Germany; §Division of Pediatric Oncology, Department of Pediatrics, University of Aachen, Aachen, Germany; ¶Division of Infectious Diseases and Hospital Epidemiology; ‖Division of Oncology, Department of Pediatrics, University of Zurich, Zurich, Switzerland; **Department of Pediatric Oncology and Hematology, Saarland University Hospital, Homburg, Saarland, Germany; ††Department of Infectious Diseases, University of Bern, Bern, Switzerland; ‡‡Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland; §§Rehabilitation Center Katharinenhoehe, Schoenwald, Germany; ¶¶Division of Oncology/Hematology, Department of Pediatrics, University Children's Hospital, Basel, Switzerland; and ‖‖Department of Pediatrics, University of Lausanne, Lausanne, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Agyeman
authors.forename: Udo
authors.initials: U
authors.lastname: Kontny
authors.forename: David
authors.initials: D
authors.lastname: Nadal
authors.forename: Kurt
authors.initials: K
authors.lastname: Leibundgut
authors.forename: Felix
authors.initials: F
authors.lastname: Niggli
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Andreas
authors.initials: A
authors.lastname: Kronenberg
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Hugo
authors.initials: H
authors.lastname: Escobar
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühne
authors.forename: Maja
authors.initials: M
authors.lastname: Beck-Popovic
authors.forename: Nicole
authors.initials: N
authors.lastname: Bodmer
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007902:Length of Stay; D009181:Mycoses / Q000150:complications / Q000382:microbiology; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications / Q000821:virology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents