Targeted strategies for pediatric cancer and post-transplant fever: the role of host and pathogen biomarkers.
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PURPOSE OF REVIEW: Host and pathogen biomarkers may lead to improved management of fever in children with cancer and post hematopoietic cell transplant (HCT). This review summarizes current evidence on biomarkers for predicting infections. RECENT FINDINGS: Host biomarkers show promise for distinguishing between infectious and noninfectious causes of fever in patients with cancer or post HCT. Combining multiple biomarkers and integrating them into risk-stratification clinical scores may enhance predictive accuracy with the potential of individualizing antimicrobial treatment. Molecular diagnostic methods like multiplex PCR provide rapid detection of many pathogens. Emerging technologies such as transcriptomics, metabolomics, and microbial metagenomic next-generation sequencing demonstrate potential but require further evaluation. Large prospective studies are needed to validate standardized cutoffs and algorithms incorporating biomarkers into clinical decision-making. The integration of host and pathogen biomarkers holds the promise of optimizing antimicrobial therapy by tailoring treatment when indicated and minimizing unnecessary antimicrobials, ultimately enhancing patient outcomes. SUMMARY: Targeted biomarker-based strategies have the potential to improve antimicrobial stewardship and outcomes in immunocompromised pediatric patients.