Early Discontinuation of Empiric Antibiotics in Pediatric Haploidentical Hematopoietic Cell Transplant Recipients With Febrile Neutropenia
Abstract
Background: Febrile neutropenia (FN) is common in children, adolescents, and young adults (CAYA) undergoing hematopoietic cell transplant (HCT), particularly following allogeneic haploidentical HCT (haplo-HCT). Optimal empiric antibiotic duration for FN is not well established in this population.
Methods: A retrospective quasi-experimental study was conducted among CAYA undergoing haplo-HCT between 2010 and 2022 who experienced FN. In 2017 a guideline was implemented for discontinuation of empiric antibiotics within 72 hours of FN in patients without identified infection regardless of persistence of fever. We compared patients who underwent haplo-HCT preimplementation (Pre-I) versus postimplementation (Post-I) of this guideline. The primary outcome was days of therapy (DOT). Secondary outcomes included incidence of bloodstream infections (BSI), intensive care unit (ICU) admission, and mortality from 72 hours of FN onset until neutrophil engraftment. A desirability of outcome ranking (DOOR) with a modified response adjusted for duration of antibiotic risk (RADAR) approach using DOT was applied to comprehensively assess outcomes.
Results: Patients in the Post-I group (n = 82) had fewer DOT compared to Pre-I (n = 90) with a median difference of 8 days (P < .01). There were no significant differences in BSI incidence, ICU admission, or mortality between groups. The DOOR–modified RADAR analysis demonstrated that Post-I was associated with a 70% (95% confidence interval, 61%–78%) probability of experiencing a more favorable clinical outcome compared to Pre-I (P < .01).
Conclusions: Early antibiotic discontinuation appears safe and feasible in CAYA haplo-HCT recipients with FN, significantly reducing antibiotic exposure without increasing adverse outcomes. Large prospective multicenter trials are needed to confirm these findings.
Related
- DETERMINANTS OF PEDIATRIC HAPLOIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION (HCT) WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE (PT-CY): THE INFLUENCE OF DONOR CHARACTERISTICS
- Association between time-to-antibiotics and clinical outcomes in neutropenic fever after hematopoietic stem cell transplant
- Case Report: SAPHO syndrome mimicking osseous relapse after haploidentical allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia
- Haploidentical hematopoietic stem cell transplantation compared to immunosuppressive therapy plus eltrombopag as first-line treatment for severe aplastic anemia patients aged 40-65: a multicenter retrospective study.
- Kinetics of early immune reconstitution and its exploratory association with post-transplant outcomes in patients undergoing haploidentical HCT with post-transplant cyclophosphamide-based GvHD prophylaxis
BibTeX
@article{castejonramirez2026early,
title = {{Early Discontinuation of Empiric Antibiotics in Pediatric Haploidentical Hematopoietic Cell Transplant Recipients With Febrile Neutropenia}},
author = {Sandra Castejon-Ramirez and Diego R Hijano and Rachel L Wattier and Jose Ferrolino and Megan Peterson and Pamela Merritt and Amber Davis and Amanda Cole and Kim J Allison and Ashleigh Gowen and Ronald Dallas and Li Tang and Jiaming Li and Brandon Triplett and Gabriela Maron},
journal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},
year = {2026},
month = may,
doi = {10.1093/cid/ciag327},
url = {https://doi.org/10.1093/cid/ciag327},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Early Discontinuation of Empiric Antibiotics in Pediatric Haploidentical Hematopoietic Cell Transplant Recipients With Febrile Neutropenia
AU - Sandra Castejon-Ramirez
AU - Diego R Hijano
AU - Rachel L Wattier
AU - Jose Ferrolino
AU - Megan Peterson
AU - Pamela Merritt
AU - Amber Davis
AU - Amanda Cole
AU - Kim J Allison
AU - Ashleigh Gowen
AU - Ronald Dallas
AU - Li Tang
AU - Jiaming Li
AU - Brandon Triplett
AU - Gabriela Maron
PY - 2026
DA - 2026/05/26
JO - Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
DO - 10.1093/cid/ciag327
UR - https://doi.org/10.1093/cid/ciag327
AB - Background: Febrile neutropenia (FN) is common in children, adolescents, and young adults (CAYA) undergoing hematopoietic cell transplant (HCT), particularly following allogeneic haploidentical HCT (haplo-HCT). Optimal empiric antibiotic duration for FN is not well established in this population. Methods: A retrospective quasi-experimental study was conducted among CAYA undergoing haplo-HCT between 2010 and 2022 who experienced FN. In 2017 a guideline was implemented for discontinuation of empiric antibiotics within 72 hours of FN in patients without identified infection regardless of persistence of fever. We compared patients who underwent haplo-HCT preimplementation (Pre-I) versus postimplementation (Post-I) of this guideline. The primary outcome was days of therapy (DOT). Secondary outcomes included incidence of bloodstream infections (BSI), intensive care unit (ICU) admission, and mortality from 72 hours of FN onset until neutrophil engraftment. A desirability of outcome ranking (DOOR) with a modified response adjusted for duration of antibiotic risk (RADAR) approach using DOT was applied to comprehensively assess outcomes. Results: Patients in the Post-I group (n = 82) had fewer DOT compared to Pre-I (n = 90) with a median difference of 8 days (P < .01). There were no significant differences in BSI incidence, ICU admission, or mortality between groups. The DOOR–modified RADAR analysis demonstrated that Post-I was associated with a 70% (95% confidence interval, 61%–78%) probability of experiencing a more favorable clinical outcome compared to Pre-I (P < .01). Conclusions: Early antibiotic discontinuation appears safe and feasible in CAYA haplo-HCT recipients with FN, significantly reducing antibiotic exposure without increasing adverse outcomes. Large prospective multicenter trials are needed to confirm these findings.
SN - 1058-4838
SN - 1537-6591
ER -