The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

de la Court, J. R.; Bruns, A. H.W.; Roukens, A. H.E.; Baas, I. O.; van Steeg, K.; Toren-Wielema, M. L.; Tersmette, M.; Blijlevens, N. M.A.; Huis in ’t Veld, R. A.G.; Wolfs, T. F.W.; Tissing, W. J.E.; Kyuchukova, Y.; Heijmans, J.

doi:https://doi.org/10.1007/s40121-022-00700-1

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

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The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer

de la Court, J. R.; Bruns, A. H.W.; Roukens, A. H.E.; Baas, I. O.; van Steeg, K.; Toren-Wielema, M. L.; Tersmette, M.; Blijlevens, N. M.A.; Huis in ’t Veld, R. A.G.; Wolfs, T. F.W.; Tissing, W. J.E.; Kyuchukova, Y.; Heijmans, J.

(2022) Infectious Diseases and Therapy, volume 11, issue 6, pp. 2063 - 2098

(Article)

Abstract

Introduction: This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and ... read more pediatric patients. Method: The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010–2020) and, where necessary, supplemented by expert-based advice. Results: For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients. Conclusion: This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin–tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended.

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Keywords: Clinical practice guideline, Hematology and febrile neutropenia, Oncology, Microbiology (medical), Infectious Diseases

DOI: https://doi.org/10.1007/s40121-022-00700-1

ISSN: 2193-8229

Publisher: Springer Healthcare

Note: Funding Information: We thank all members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, Dutch Society for Pediatrics, and the Dutch Working Party on Antibiotic Policy (SWAB) for their support and feedback. Springer Healthcare is not responsible for the validity of guidelines it publishes. For the development of this guideline, the SWAB was funded by the National Institute for Public Health and the Environment, the Netherlands. The Rapid Service Fee was funded by the AMC Medical Research department. The literature searches are performed by Jara R. de la Court and J. Heijmans and discussed in guideline meetings with all co-authors. The first draft of the manuscript was written by Jara R. de la Court and J. Heijmans and all authors commented on earlier versions of the manuscript. All authors read and approved the final manuscript. The Dutch Working Party on Antibiotic Policy (SWAB) employs strict guidelines with regard to potential conflicts of interests, as described in the SWAB Format for Guideline Development (www.swab.nl). All members of the guideline committee complied with the SWAB policy on conflicts of interest, which requires disclosure of any financial or other interest that might be construed as constituting an actual, potential, or apparent conflict. Members of the guideline committee were provided the SWAB conflict of interest disclosure statement and were asked to identify ties to companies developing products or other parties that might be affected by the guideline. Information was requested regarding employment, honoraria, consultancies, stock ownership, research funding, and membership on company advisory committees. The panel made decisions on a case-by-case basis as to whether an individual’s role should be limited as a result of a conflict. Potential conflicts: Dr. I. Baas: reimbursement of travel expenses by Roche. J.R. de la Court, A.H.W. Bruns, A.H.E. Roukens, K. van Steeg, M.L. Toren-Wielema, M. Tersmette, N.M.A. Blijlevens, R.A.G. Huis in ’t Veld , T.F.W. Wolfs, dr. W.J.E. Tissing, Y. Kyuchukova, J. Heijmans have nothing to disclose. This guideline is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. This manuscript does not contain any individual person’s data. We were granted permission to republish this guideline from both “Nederlandse Tijdschrift voor Hematologie” (NtvH) and the Dutch Working Party on Antimicrobial Policies (SWAB). Figure 1 was reprinted with permission from Ned Tijdschr Hematol 2022;19(4):171–8 as stated beneath the figure. This manuscript was slightly adapted from the original guideline that was published online by SWAB [4 ]. Based on reviewers’ comments, textual clarifications were added, but no substantial changes were made to recommendations. The guideline articulates the prevailing professional standard in diagnosis and management of febrile neutropenia in patients with cancer in the Netherlands and contains general recommendations for the antibiotic treatment of hospitalized adults and children and outpatient treatment of adults. It is possible that these recommendations are not applicable in an individual patient case. The applicability of the guideline in clinical practice is the responsibility of the treating physician. There may be facts or circumstances in which, in the interest of proper patient care, non-adherence to the guideline is desirable. These guidelines were prepared and approved by the SWAB and do not necessarily reflect the opinions of Infectious Diseases and Therapy or its Editors. SWAB intends to revise their guidelines every 5 years. The potential need for earlier revisions will be determined by the SWAB board at annual intervals, on the basis of an examination of current literature. If necessary, the guidelines committee will be reconvened to discuss potential changes. When appropriate, the committee will recommend expedited revision of the guideline to the SWAB board. Therefore, in 2026 or earlier if necessary, the guideline will be re-evaluated. All data generated or analyzed during this study are included in this published article/as supplementary information files. Funding Information: For the development of this guideline, the SWAB was funded by the National Institute for Public Health and the Environment, the Netherlands. The Rapid Service Fee was funded by the AMC Medical Research department. Publisher Copyright: © 2022, The Author(s).

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