Phillips Robert, Fisher Brian T, Ladas Elena J, Patel Priya, Robinson Paula D, Dupuis L Lee, Ammann Roland A, Beauchemin Melissa P, Carlesse Fabianne, Castagnola Elio, Davis Bonnie L, Efremov Kirsten, Elgarten Caitlin W, Groll Andreas H, Haeusler Gabrielle M, Koenig Christa, Morris Alisa, Santolaya Maria Elena, Spinelli Daniela, Tissing Wim J E, Wolf Joshua, Sung Lillian, Lehrnbecher Thomas
Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK.
EClinicalMedicine. 2025 Feb 12;81:103093. doi: 10.1016/j.eclinm.2025.103093. eCollection 2025 Mar.
Food restrictions during periods of neutropenia have been widely used in oncology settings to prevent infections. As there is a lack of clearly demonstrated effectiveness, this strategy is being increasingly questioned.
A multi-national panel of 23 individuals was convened to develop a clinical practice guideline (CPG) on the use of food restrictions to prevent infections in paediatric patients with cancer and haematopoietic cell transplantation (HCT) recipients. It included representation from persons with lived experience and physicians, dieticians, nurses, pharmacists and guideline methodologists working in paediatric oncology/HCT or infectious diseases. Panel members (female n = 15; 65%) were from North America (12, 52%), Europe (8, 35%), South America (2, 9%) and Australia (1, 4%). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to formulate the CPG recommendations based on a systematic review of randomised controlled trials (RCTs). MEDLINE, MEDLINE in-Process and Embase databases were searched from January 1, 1980, to May 7, 2024, with a broad strategy which combined subject headings and text words relating to neutropenia, infection and diet.
The systematic review, which provided the evidence base for the CPG recommendations, identified 4312 unique citations, of which 52 were retrieved for full-text evaluation. Eight RCTs met the eligibility criteria and informed panel deliberations. Although there was clinical heterogeneity in the food restrictions evaluated, data were consistent in suggesting that food restrictions lack clinically significant benefit in preventing infections. The panel made two conditional recommendations against the use of food restrictions in a) paediatric patients with cancer receiving chemotherapy and b) in the setting of allogeneic and autologous HCT. The panel developed a good practice statement to emphasise the importance of health care organisations and families adhering to local food safety practices.
This CPG provides the first evidence-based recommendations on use of food restrictions to prevent infections in children and adolescents undergoing chemotherapy and paediatric haematopoietic cell transplant recipients.
This CPG was funded and developed through the POGO Guidelines Program.
在肿瘤治疗环境中，中性粒细胞减少期间的食物限制已被广泛用于预防感染。由于缺乏明确证实的有效性，这一策略受到越来越多的质疑。
召集了一个由23人组成的多国小组，制定关于使用食物限制来预防患有癌症的儿科患者和造血干细胞移植（HCT）受者感染的临床实践指南（CPG）。小组成员包括有实际经验的人员以及在儿科肿瘤学/HCT或传染病领域工作的医生、营养师、护士、药剂师和指南方法学家。小组成员（女性n = 15；65%）来自北美（12人，52%）、欧洲（8人，35%）、南美（2人，9%）和澳大利亚（1人，4%）。采用推荐分级评估、制定和评价（GRADE）方法，基于对随机对照试验（RCT）的系统评价制定CPG建议。检索了1980年1月1日至2024年5月7日的MEDLINE、MEDLINE在研数据库和Embase数据库，采用了一种广泛的策略，将与中性粒细胞减少、感染和饮食相关的主题词和文本词相结合。
为CPG建议提供证据基础的系统评价共识别出43,12条独特的引文，其中52条被检索出来进行全文评估。八项RCT符合纳入标准，并为小组讨论提供了信息。尽管所评估的食物限制存在临床异质性，但数据一致表明食物限制在预防感染方面缺乏临床显著益处。小组提出了两项有条件的建议，反对在以下情况使用食物限制：a）接受化疗的患有癌症的儿科患者；b）在同种异体和自体HCT的情况下。小组制定了一份良好实践声明，以强调医疗机构和家庭遵守当地食品安全做法的重要性。
本CPG提供了关于使用食物限制来预防接受化疗的儿童和青少年以及儿科造血干细胞移植受者感染的首批循证建议。
本CPG由POGO指南项目资助和制定。
