title: Risk-adapted approach for fever and neutropenia in paediatric cancer patients--a national multicentre study.
abstract: BACKGROUND
  In this national multicentre study, we examined the safety of reducing antibiotics in selected paediatric cancer patients with febrile neutropenia.
  
  
  METHODS
  Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk and received antibiotic therapy. Remaining patients were allocated to low- or medium risk, depending on their interleukin-8 level. Low-risk patients did not receive any antibiotics and were discharged from the hospital after having been afebrile for 12 h. Medium-risk patients were re-evaluated after 72 h of antibiotic treatment and, in selected patients, antibiotics were stopped.
  
  
  RESULTS
  Two hundred thirty-three febrile neutropenic episodes in 141 paediatric cancer patients were included in the study. Sixty-four episodes were classified high risk (28%), 122 medium risk (52%), and 47 (20%) low risk. In the medium-risk group, antibiotics were stopped after 72 h in 50 in 122 episodes (41%). Median duration of antibiotic treatment and hospital admission was significantly lower in low- and medium-risk episodes with early discharge. No failures were observed in the medium-risk group with early discharge. In the low-risk group, six failures were observed (12.8%), due to coagulase-negative staphylococci-positive blood cultures and recurrent fever.
  
  
  CONCLUSIONS
  We showed that it is safe to shorten antibiotic treatment to 72 h in selected medium-risk patients with febrile neutropenia, regardless of the neutrophil count. The safety of withholding antibiotics in selected low-risk paediatric cancer patients with febrile neutropenia requires further investigation, using more suitable definitions for safety. Reduction in hospital admissions allows children with cancer more time at home and consequently improves their quality of life.
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Karin G E
authors.initials: KG
authors.lastname: Miedema
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: w.j.e.tissing@umcg.nl.
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.affiliation: Department of Pediatric Oncology and Hematology, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Floor C H
authors.initials: FC
authors.lastname: Abbink
authors.affiliation: Department of Pediatric Oncology and Hematology, Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Ball
authors.affiliation: Department of Pediatric Oncology and Hematology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Erna M C
authors.initials: EM
authors.lastname: Michiels
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Michel J
authors.initials: MJ
authors.lastname: van Vliet
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Wilma Y
authors.initials: WY
authors.lastname: de Vries
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Kamps
authors.affiliation: Department of Pediatrics, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: Obbe F
authors.initials: OF
authors.lastname: Norbruis
authors.affiliation: Dutch Childhood Oncology Group (SKION), The Hague, the Netherlands; Mathematical Institute, Leiden University, Leiden, the Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Dutch Childhood Oncology Group (SKION), The Hague, the Netherlands.
authors.forename: Hester A
authors.initials: HA
authors.lastname: de Groot-Kruseman
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.affiliation: Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Eveline S J M
authors.initials: ES
authors.lastname: de Bont
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents
keywords: Antibiotics; Children; Fever; IL-8; Neutropenia; Risk assessment model