Adherence to the febrile neutropenia protocol in pediatric leukemia patients at a Brazilian Cancer Center-A retrospective audit.
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Pediatric patients with hematologic cancers, especially those undergoing chemotherapy, are highly vulnerable to infections and febrile neutropenia (FN). Noncompliance with FN protocols often leads to excessive antibiotic use, raising the risk of multidrug-resistant bacteria and contributing to higher mortality rates. This retrospective study aimed to assess inappropriate empirical antibiotic treatment (IEAT) rates during FN episodes and identify risk factors for mortality among pediatric patients diagnosed with acute leukemia and FN at the A.C. Camargo Cancer Center between January 1, 2010, and December 31, 2020. A total of 329 FN episodes in 84 patients were analyzed, revealing an overall IEAT rate of 40%. The study identified key issues such as 2% of inadequate Gram-positive coverage, 78% of failure to de-escalate antibiotic treatment and 62% of maintenance antibiotic administration despite negative cultures Bloodstream infections were found in 77% of episodes, with age over 13 years (p 0.003), and bloodstream infection (p 0.002) being significant risk factors for mortality.