EARLY DISCONTINUATION OF ANTIBIOTICS IN PEDIATRIC PATIENTS WITH LOW- AND HIGH-RISK FEBRILE NEUTROPENIA: A...

Maintaining broad-spectrum antibiotics until resolution of fever and recovery of absolute neutrophil count (ANC) has traditionally been the standard approach for pediatric patients with cancer and for hematopoietic stem-cell transplantation (HSCT) recipients who present with febrile neutropenia (FN). Recent studies in adults support the safety of discontinuing empiric antibiotic treatment (EAT) prior to ANC recovery. However, data in children remain limited.

Retrospective study that included patients under 18 years of age with cancer and/or undergoing HSCT admitted with FN between June 2022 and August 2023, in whom EAT was discontinued prior to ANC ≥500/mm3. Patients already receiving antibiotics for a documented or suspected source of bacterial infection, sepsis, or admitted to PICU were excluded. We report the characteristics and clinical outcomes (readmission, new fever onset, and new infection) within 7 days of the discontinuation of EAT, as well as the 30-day PICU admission, infection-related mortality and all-cause mortality rates.

We included 97 episodes (65 patients) of FN, 47 (48.4%) occurred in children with hematologic disease (malignant or non-malignant), including patients who had received an HSCT (n=8) and/or a CAR-T (n=6). Fever lasted less than 24 hours in 75.3% of episodes. Median EAT duration was 3 days (IQR: 3-5). ANC recovery occurred at a median of 4 days (IQR 2-12) after EAT discontinuation. Fever recurred in 11 episodes (11.3%) within 7 days from EAT discontinuation. An infectious cause was identified in 3/11 episodes (mild bacterial folliculitis, probable primary Cytomegalovirus infection, and invasive fungal infection, n=1 each). No admissions to PICU or 30-day infection-related mortality were observed. Two patients died because of non-infectious causes.

Early EAT discontinuation before ANC recovery in selected pediatric patients with FN, including high-risk patients, may reduce hospitalization and antibiotic exposure.