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