Recent advances and future directions in the management of the immunocompromised host.

Infectious complications are still a major cause of morbidity and mortality in children receiving therapy for cancer or undergoing hematopoietic stem cell transplantation. Current supportive care strategies consider numerous factors for defining the risk for an infection, but these risk-prediction models need to be refined to ultimately personalize anti-infective measures for an individual patient. It has been recognized that the performance of diagnostic tools including serum markers and imaging may differ between children and adults, and future studies have to assess in the pediatric population the combination of specific diagnostic tools in order to improve the early and reliable diagnosis of an infection. There is an ongoing debate on systemic anti-bacterial and antifungal prophylaxis, as these strategies have to weigh individual benefits of reducing infectious complications against the risk of increasing resistance rates in patients and within institutions. Although there was considerable progress in supportive anti-infective care strategies in children and adolescents over the last 2 decades, which resulted in the development of pediatric specific clinical practice guidelines, major effort is needed to close the open research gaps.