[Antibiotic use following pediatric hematopoietic stem cell transplantation (SFGM-TC)]

Hematopoietic stem cell transplantation (HSCT) is associated withmarked and prolonged neutropenia, resulting in a high risk of severe infections and warranting the use of broad-spectrum empirical antibiotics in patients with fever. The risk of infection begins before the onset of aplasia and persists beyond the neutropenic phase. However, the efficacy of antibiotic prophylaxis and the risk-benefit balance associated with the empirical use of broad-spectrum antibiotics remain insufficiently evaluated in pediatric patients. Our working group assessed current clinical practices using a questionnaire sent to SFGM-TC (Société Francophone de Greffe de Moelle et de Thérapie Cellulaire) pediatric centers and reviewed original studies and published reviews identified in the literature to formulate recommendations. These recommendations address the use of empirical and prophylactic antibiotic therapy according to the post-HSCT period and the optimization of high-dose antibacterial therapy in pediatric patients. Additionally, we evaluated the impact of these strategies on the gut microbiota and post-HSCT outcomes in children.