Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions

doi:10.1002/pbc.31532

. 2025 Mar;72(3):e31532.

doi: 10.1002/pbc.31532. Epub 2025 Jan 8.

Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions

Leonora R Slatnick¹, David Hoogstra², Brian T Fisher³, Joshua Wolf⁴, Etan Orgel⁵, C Nathan Nessle⁶, Pratik A Patel⁷, Tamara P Miller⁷, Jennifer Wilkes⁸, L Lee Dupuis⁹, Erin Goode^{10

11}, Kasey Jackson¹², Daniel N Willis¹³, Caitlin Elgarten³, Catherine Aftandilian¹⁴, Joel Thompson¹⁵, Sarah Alexander¹⁶, Melissa P Beauchemin¹⁷, Jennifer A Belsky¹⁸, Jennifer Hess¹⁹, Zachary D Prudowsky²⁰, Terri Guinipero²¹, Jenna Rossoff²², Jenna Demedis²³, Alexandra M Walsh²⁴, Rebecca Richards²⁵, Daniel K Choi²⁶, Christopher C Dvorak²⁷, Adam J Esbenshade²⁸

Affiliations

¹ Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah, USA.
² Department of Pediatrics, Helen Devos Children's Hospital, Grand Rapids, Michigan, USA.
³ Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁴ Departments of Infectious Diseases and Pediatrics, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁵ Cancer and Blood Disease Institute, Children's Hospital of Los Angeles Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁶ Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Pediatric Hematology/Oncology and Pediatric Infectious Disease, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁸ Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.
⁹ Department of Pharmacy, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
¹⁰ Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA.
¹¹ Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA.
¹² Division of Pediatric Hematology/Oncology, Cook Children's Hospital, Fort Worth, Texas, USA.
¹³ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA.
¹⁴ Department of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, California, USA.
¹⁵ Division of Hematology/Oncology/BMT, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.
¹⁶ Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
¹⁷ Columbia University/Herbert Irving Cancer Center, Columbia University School of Nursing, New York, New York, USA.
¹⁸ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁹ Children's Hospital of Minnesota, Minneapolis, Minnesota, USA.
²⁰ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
²¹ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
²² Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²³ Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, Colorado, USA.
²⁴ Phoenix Children's Hospital, Phoenix, Arizona, USA.
²⁵ Division of Pediatric Hematology, Oncology, Stem Cell Transplantation and Cell Therapy, University of Wisconsin-Madison, Wisconsin, Madison, USA.
²⁶ Adocate Children's Hospital Health, Park Ridge, Illinois, USA.
²⁷ Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, California, USA.
²⁸ Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.

PMID: 39780366
PMCID: PMC12227264 (available on 2026-03-01)
DOI: 10.1002/pbc.31532

Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions

Leonora R Slatnick et al. Pediatr Blood Cancer. 2025 Mar.

. 2025 Mar;72(3):e31532.

doi: 10.1002/pbc.31532. Epub 2025 Jan 8.

Authors

Affiliations

¹ Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah, USA.
² Department of Pediatrics, Helen Devos Children's Hospital, Grand Rapids, Michigan, USA.
³ Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁴ Departments of Infectious Diseases and Pediatrics, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁵ Cancer and Blood Disease Institute, Children's Hospital of Los Angeles Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁶ Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Pediatric Hematology/Oncology and Pediatric Infectious Disease, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁸ Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.
⁹ Department of Pharmacy, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
¹⁰ Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Detroit, Michigan, USA.
¹¹ Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA.
¹² Division of Pediatric Hematology/Oncology, Cook Children's Hospital, Fort Worth, Texas, USA.
¹³ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA.
¹⁴ Department of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, California, USA.
¹⁵ Division of Hematology/Oncology/BMT, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.
¹⁶ Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
¹⁷ Columbia University/Herbert Irving Cancer Center, Columbia University School of Nursing, New York, New York, USA.
¹⁸ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁹ Children's Hospital of Minnesota, Minneapolis, Minnesota, USA.
²⁰ Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
²¹ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
²² Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²³ Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Colorado Anschutz Medical Center, Children's Hospital Colorado, Aurora, Colorado, USA.
²⁴ Phoenix Children's Hospital, Phoenix, Arizona, USA.
²⁵ Division of Pediatric Hematology, Oncology, Stem Cell Transplantation and Cell Therapy, University of Wisconsin-Madison, Wisconsin, Madison, USA.
²⁶ Adocate Children's Hospital Health, Park Ridge, Illinois, USA.
²⁷ Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, California, USA.
²⁸ Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt and the Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.

PMID: 39780366
PMCID: PMC12227264 (available on 2026-03-01)
DOI: 10.1002/pbc.31532

Abstract

Introduction: While clinical practice guidelines (CPGs) for pediatric oncology infection prophylaxis and management exist, few data describe actual management occurring at pediatric oncology centers.

Methods: An electronic survey querying infection management practices in nontransplant pediatric oncology patients was iteratively created by the Children's Oncology Group (COG) Cancer Control and Supportive Care Infectious Diseases Subcommittee and sent to leaders at all COG institutions, limiting each site to one response to represent their institution.

Results: The response rate was 57% (129/227 institutions). Many sites reported utilizing COG-endorsed CPGs for antibacterial (76%) and antifungal prophylaxis (74%), and fever and neutropenia (FN, 64%). Most institutions reported using antimicrobial prophylaxis for patients with acute myeloid leukemia (88% antibacterial, 100% antifungal) and relapsed acute lymphoblastic leukemia (82% antibacterial, 95% antifungal). Definitions of fever, phagocyte recovery, and antibiotic duration in febrile patients varied. Most institutions administer empiric broad-spectrum antibiotics for nonneutropenic fever, although 14% reported withholding antibiotics based on initial clinical status or risk stratification tools. Most respondents reported (70%) admitting FN patients for at least 48 h, however 15% have low-risk FN protocols allowing outpatient management. FN patients remain admitted on antibiotics through count recovery in 50% of institutions, whereas the others employed various early discharge/early antibiotic discontinuation strategies.

Conclusions: There is often consistency but also substantial variability in reported antimicrobial prophylaxis strategies and management of patients with fever and represents an opportunity for implementation studies to standardize application of CPG recommendations and randomized trials to advance evidence where knowledge gaps exist.

Keywords: Children's Oncology Group; febrile neutropenia; fungal prophylaxis; infectious complications; pediatric oncology; supportive care.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

Etan Orgel provided consulting services to Jazz Pharmaceuticals. Leonora R. Slatnick provided consulting services to Y-mAbs Therapeutics. Brian T. Fisher received research support from Merck and Pfizer, and also worked for data safety monitoring board for Astellas. Joshua Wolf acknowledges Karius Inc., Scynexis Inc., and Pfizer Inc. for in kind support for investigator-initiated research, and Merck Inc. for participation in industry-initiated research. The remaining authors declare no conflicts of interest.

References

1. Lehrnbecher T, Fisher BT, Phillips B, et al. , “Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation,” Clinical Infectious Diseases 71, no. 1 (2020): 226–236, 10.1093/cid/ciz1082. - DOI - PMC - PubMed
1. Lehrnbecher T, Fisher BT, Phillips B, et al. , “Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients with Cancer and Hematopoietic Stem-Cell Transplantation Recipients,” Journal of Clinical Oncology 38, no. 27 (2020): 3205–3216, 10.1200/JCO.20.00158. - DOI - PMC - PubMed
1. Lehrnbecher T, Robinson PD, Ammann RA, et al. , “Guideline for the Management of Fever and Neutropenia in Pediatric Patients with Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update,” Journal of Clinical Oncology 41, no. 9 (2023): 1774–1785, 10.1200/JCO.22.02224. - DOI - PMC - PubMed
1. Patel P, Robinson PD, Fisher BT, et al. , “Guideline for the Management of Clostridioides difficile Infection in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2024 Update,” EClinicalMedicine 72 (2024): 102604, 10.1016/j.eclinm.2024.102604. - DOI - PMC - PubMed
1. Lehrnbecher T, Robinson P, Fisher B, et al. , “Guideline for the Management of Fever and Neutropenia in Children with Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update,” Journal of Clinical Oncology 35, no. 18 (2017): 2082–2094, 10.1200/JCO.2016.71.7017. - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

Grants and funding

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

[1] Lehrnbecher T, Fisher BT, Phillips B, et al. , “Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation,” Clinical Infectious Diseases 71, no. 1 (2020): 226–236, 10.1093/cid/ciz1082. - DOI - PMC - PubMed

[2] Lehrnbecher T, Fisher BT, Phillips B, et al. , “Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation,” Clinical Infectious Diseases 71, no. 1 (2020): 226–236, 10.1093/cid/ciz1082. - DOI - PMC - PubMed

[3] Lehrnbecher T, Fisher BT, Phillips B, et al. , “Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients with Cancer and Hematopoietic Stem-Cell Transplantation Recipients,” Journal of Clinical Oncology 38, no. 27 (2020): 3205–3216, 10.1200/JCO.20.00158. - DOI - PMC - PubMed

[4] Lehrnbecher T, Fisher BT, Phillips B, et al. , “Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients with Cancer and Hematopoietic Stem-Cell Transplantation Recipients,” Journal of Clinical Oncology 38, no. 27 (2020): 3205–3216, 10.1200/JCO.20.00158. - DOI - PMC - PubMed

[5] Lehrnbecher T, Robinson PD, Ammann RA, et al. , “Guideline for the Management of Fever and Neutropenia in Pediatric Patients with Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update,” Journal of Clinical Oncology 41, no. 9 (2023): 1774–1785, 10.1200/JCO.22.02224. - DOI - PMC - PubMed

[6] Lehrnbecher T, Robinson PD, Ammann RA, et al. , “Guideline for the Management of Fever and Neutropenia in Pediatric Patients with Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update,” Journal of Clinical Oncology 41, no. 9 (2023): 1774–1785, 10.1200/JCO.22.02224. - DOI - PMC - PubMed

[7] Patel P, Robinson PD, Fisher BT, et al. , “Guideline for the Management of Clostridioides difficile Infection in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2024 Update,” EClinicalMedicine 72 (2024): 102604, 10.1016/j.eclinm.2024.102604. - DOI - PMC - PubMed

[8] Patel P, Robinson PD, Fisher BT, et al. , “Guideline for the Management of Clostridioides difficile Infection in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2024 Update,” EClinicalMedicine 72 (2024): 102604, 10.1016/j.eclinm.2024.102604. - DOI - PMC - PubMed

[9] Lehrnbecher T, Robinson P, Fisher B, et al. , “Guideline for the Management of Fever and Neutropenia in Children with Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update,” Journal of Clinical Oncology 35, no. 18 (2017): 2082–2094, 10.1200/JCO.2016.71.7017. - DOI - PubMed

[10] Lehrnbecher T, Robinson P, Fisher B, et al. , “Guideline for the Management of Fever and Neutropenia in Children with Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update,” Journal of Clinical Oncology 35, no. 18 (2017): 2082–2094, 10.1200/JCO.2016.71.7017. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions

Affiliations

Prevention and Management of Infectious Complications in Pediatric Patients With Cancer: A Survey Assessment of Current Practices Across Children's Oncology Group Institutions

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous

Abstract

Conflict of interest statement

Similar articles

References

MeSH terms

Substances

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous