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Blood Stream Infections and Antibiotic Utilization in Pediatric Leukemia Patients With Febrile Neutropenia

Reinecke, James, MD*; Lowas, Stefanie, MD; Snowden, Jessica, MD; Neemann, Kari, MD

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p 251–255
doi: 10.1097/MPH.0000000000001279
Original Articles

Background: Frequent surveillance of bacterial pathogens responsible for microbiologically defined-blood stream infections (MD-BSI), and their respective antibiotic susceptibilities is central to tailoring empiric antibiotic therapy in febrile neutropenia (FN) episodes in pediatric patients with leukemia. The safety of deescalating antibiotic therapy in pediatric patients with leukemia and neutropenia is incompletely understood.

Methods: A retrospective chart review of 194 FN episodes occurred between the years of 2013 and 2016 in 67 patients with leukemia. Clinical and microbiologic data were recorded.

Results: MD-BSI occurred in 36 of 194 (18%) of FN episodes. Deescalation of empiric antibiotic therapy based on antibiotic susceptibilities was possible in 25 of 36 (69.4%) episodes. In those 25 episodes, where there was an opportunity to deescalate the antibiotic spectrum, it was clinically appropriate to do so in 19. Deescalation occurred in 9 (47.4%) of these episodes without complication. The remaining 10 patients received a median of 20 additional days of broad-spectrum antibiotic therapy (range, 12 to 30 d).

Conclusions: In our small cohort of patients, deescalation of antibiotic therapy based on antimicrobial susceptibilities did not result in complication. Larger prospective studies are needed to address the safety of deescalating antibiotic therapy in this population.

*Department of Pediatrics, University of Nebraska Medical Center

Departments of Pediatrics, Division of Hematology/Oncology

Pediatrics, Division of Infectious diseases, University of Nebraska Medical Center and Children’s Hospital and Medical Center, Omaha, NE

Present address: James Reinecke, MD, Department of Pediatrics, University of Iowa Stead Family Children’s Hospital Iowa City, IA 52242.

The authors declare no conflict of interest.

Reprints: Kari Neemann, MD, 982162 Nebraska Medical Center, Omaha, NE 68198-2162 (e-mail:

Received February 16, 2018

Accepted July 7, 2018

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