title: Management of fever and neutropenia in paediatric cancer patients: room for improvement?
abstract: OBJECTIVE
  Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts.
  
  
  RESULTS
  A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis. Emerging evidence suggests acute fever and neutropenia management strategies should include time to antibiotic recommendations, and quality improvement initiatives have focused on eliminating barriers to early antibiotic administration. Despite reported increases in antimicrobial resistance, few studies have focused on the prediction, prevention, and optimal treatment of these infections and the effect on risk stratification remains unknown. A consensus guideline for paediatric fever and neutropenia research is now available and may help reduce some of the heterogeneity between studies that have previously limited the translation of evidence into clinical practice.
  
  
  CONCLUSIONS
  Risk stratification is recommended for children with cancer and fever and neutropenia. Further research is required to quantify the overall impact of this approach and to refine exactly which children will benefit from early antibiotic administration as well as modifications to empiric regimens to cover antibiotic-resistant organisms.
authors.affiliation: aDepartment of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre bInfection and Immunity, Department of Paediatrics, Monash Children's Hospital, Monash Health, Melbourne cPaediatric Integrated Cancer Service, Victoria, Australia dDivision of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada eDepartment of Paediatrics, University of Bern, Bern, Switzerland fCentre for Reviews and Dissemination, University of York, York gPaediatric Oncology, Leeds Children's Hospital, Leeds, UK.
authors.forename: Gabrielle M
authors.initials: GM
authors.lastname: Haeusler
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents