• Philipp Agyeman, Udo Kontny, David Nadal, Kurt Leibundgut, Felix Niggli, Arne Simon, Andreas Kronenberg, Reno Frei, Hugo Escobar, Thomas Kühne, Maja Beck-Popovic, Nicole Bodmer, and Roland A Ammann.
• 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.
• Pediatr. Infect. Dis. J. 2014 Sep 1;33(9):e219-25.

BackgroundFever 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.MethodsMicrobiologically 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.ResultsMDI 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].ConclusionsMDI 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.

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