Data collection
Children receiving only prophylactic antibiotics were included, while
children who were already on intravenous antibiotics for a previous
infection the day before the initiation of the new antibiotic regimen
were excluded. Administration of any antifungal therapy in a child with
FN was recorded as empirical therapy. No pediatric patient was recorded
twice within the same month, and the form was completed for the first
seven days of antibiotic administration.
Data recorded included age and sex, presence of central lines, type of
underlying disease (hematologic malignancy, solid tumor, or other
disease), ANC and its relation to the first day of antibiotic therapy,
antibiotics used and their indication (empirical or targeted therapy,
perioperative or other prophylaxis), cultures obtained, and pathogens
isolated, presence or absence of invasive fungal disease (IFD), and
clinical outcome (hospital discharge, ICU admission, or death).
In December 2017, a meeting between CLEO representatives and the
directors of all PHO units took place, where baseline data analysis was
presented along with the main conclusions. Finally, the goal of
implementing the recently updated at that time clinical practice
guidelines (CPG) for the management of FN in children with cancer and
HSCT recipients by the International Pediatric Fever and Neutropenia
Guideline Panel was also discussed.13 The timeframe
and the goals of the PHIG intervention are shown in Figure 1 .
For FN, the definition of the Infectious Diseases Society of America
(IDSA) was used.17