Satty Alexandra, Stiefel Jessica, Mauguen Audrey, Hudda Zahra, Lakkaraja Madhavi, Llaurador Gabriela, Rendon Bernot Mauricio, Seo Susan K, Bender Julia Glade, Sulis Maria Luisa, Boulad Farid
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Pediatr Hematol Oncol. 2025 May;42(4):242-249. doi: 10.1080/08880018.2025.2498664. Epub 2025 May 7.
The management of non-neutropenic fever in pediatric oncology varies widely, with many providers choosing to administer empiric antibiotics. We conducted a quality improvement intervention seeking to decrease empiric antibiotic administration in pediatric oncology patients with a central venous catheter presenting in the outpatient setting with non-neutropenic fever assessed to be low-risk for bacteremia. Over a 1-year period, empiric antibiotics were administered at the index visit in 9.6% of episodes, compared with 97% prior to the intervention. In patients not receiving empiric antibiotics, the bacteremia rate was 2.3% and composite event rate 5.1%, similar to pre-intervention baseline. These data suggest that empiric antibiotics can be withheld in low-risk patients with non-neutropenic fever.
小儿肿瘤学中非中性粒细胞减少性发热的管理差异很大，许多医疗服务提供者选择使用经验性抗生素。我们进行了一项质量改进干预措施，旨在减少门诊环境中出现非中性粒细胞减少性发热且评估为菌血症低风险的中心静脉导管置入的小儿肿瘤患者的经验性抗生素使用。在1年的时间里，9.6%的病例在首次就诊时使用了经验性抗生素，而干预前这一比例为97%。在未接受经验性抗生素治疗的患者中，菌血症发生率为2.3%，复合事件发生率为5.1%，与干预前基线相似。这些数据表明，对于非中性粒细胞减少性发热的低风险患者，可以不使用经验性抗生素。
