Purpose To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. ...Methods The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Results Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.
In cancer control research, the objective is to reduce overall morbidity and mortality by decreasing acute and delayed treatment-related toxicities in all children with cancer. To date, the ...Children’s Oncology Group (COG) has focused on infection, neurocognition, quality of life (QoL), and nutrition/antiemetics. COG is conducting randomized controlled trials (RCTs) to determine prophylaxis strategies that will reduce infections in high-risk populations. Two RCTs are determining if modafinil or computerized cognitive training improve cognitive functioning in pediatric brain tumor patients. QoL is being assessed in acute leukemia patients. Improved supportive care outcomes will only occur when the most effective interventions are established.
Background: Healthcare-associated infections (HAI) are associated with increased morbidity and mortality and excess costs. Central line-associated bloodstream infections (CLABSI) are the most common ...HAI in neonates and children. The aim of this study was to develop a CLABSI collaborative network in neonatal and pediatric intensive care units and pediatric oncology units. Secondary objectives were to collect national benchmark data for CLABSI rates, isolated pathogens and antimicrobial susceptibility rates.Methods: Active surveillance for CLABSIs was conducted from June 2016 to February 2017. A collaborative network of 14 NICUs, 5 PICUs and 6 Pediatric Oncology Units (ONCs) participated in the program. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event and CLABSI rate were based on 2014 Centers for Disease Control and Preventionsu2019 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL days, patient days and susceptibility of isolated organisms.Results: A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL days and CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs and 2.78 per 1000 CL days in ONCs (Table 1). A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%) followed by Gram-positive cocci (30%), non-fermenting Gram-negative bacteria (17%) and fungi (16%). Overall 38.5% and 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and carbapenems, respectively.Conclusions: Nation-wide CLABSI rates were determined for pediatric patients. A worrying finding was the identification of high rates of carbapenem-resistant organisms. These data could be used to benchmark and serve as baseline data for the design and evaluation of infection control and antimicrobial stewardship interventions.
Background: Hand hygiene(HH) is the most important measure to prevent healthcare associated infections and avoid transmission of pathogens. The aim of the study was to determine HH compliance rates ...in pediatric units and identify barriers to compliance among health care workers (HCWs).Methods: An observational study for HH rates was carried out in 25 pediatric units(15 NICUs, 4 PICUsand 6 oncology units)from June2016 to February 2017 in 14 hospitals in Greece. Observations were collected during all the shifts in wards by trained on HH methods observers, using a data collection form based upon tools from WHO.At the end of this period,aquestionnaire was provided to HCWsto detect the possible barriers for HH compliance.Results: A total of 6472 HH opportunities were observed.The total HH compliance rate was 71.04% and the rate of appropriate HH was 52.15%(Table 1). 749HCWs from all units were questioned to declare their beliefs about the barriers for HH(response rate:48.3%). As main barriers were detected: the emergency situation(73.5%), distraction from many responsibilities during the patient care(47.0%), great workload (34.3%),and skin irritation from hand cleaning product(24.3%).Almost half of therespondentsdid not participate in HH educational activity during the past year.Conclusion:HH compliance rates among pediatric units are highbut still have the potential of improvement. Some of the reasons that reported by HCWs beliefs can be used to increase the HH ratesduring the intervention period.Defining the specific causes of HH failurerequire more specific interventions targeted to its most important causes.
Background:Active daily surveillance of central line days (CLDs) in the assessment of CLABSI rates is time consuming and burdensome for healthcare workers. Sampling of denominator data is a method ...that could reduce the time necessary to conduct active surveillance. Our objective was to evaluate the accuracy of CLD estimates using various sampling strategies in neonatal and pediatric departments in Greece and to assess the impact on CLABSI rates.Methods:Daily denominator data were collected in 22 units (4 PICUs, 12 NICUS and 6 ONCs) across Greece for 6 consecutive months. 32 sampling strategies were evaluated using the original data as following: 1 fixed day/week, 2 fixed days/week and 1 fixed week/month. CLDs for each month were estimated as follows: (number of CLDs in the sample/number of sampled days/month)*30. The estimated CLDs were used to calculate CLABSI rates. The accuracy of the estimated CLABSI rates was assessed by calculating the percentage error (observed CLABSI rates-estimated CLABSI rates)/observed CLABSI rates.Results:The sampling over 2 fixed days/ week seems to provide the most accurate estimates of the monthly CLABSI rates for all the different types of units compared to other strategies (1 fixed day/week, and 1 fixed week/month). The percentage error was found to be u22645% in u226585% of months in which sampling was conducted, for several day-pair samples as presented in Table 1. Moreover, results showed that lower number of CLD per month (cut-off 75 days) lead to more accurate estimate of CLABSI rates. Conclusion:Sampling over 2 fixed days per week seems to provide a valid alternative to daily collection of CLABSI denominator data. These findings and similar strategies should be evaluated for the surveillance of other healthcare-associated infections.
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