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A reaudit of current febrile neutropenia practice in UK paediatric oncology centres prior to implementation of NICE guidance
  1. Jessica Bate1,
  2. Faith Gibson2,
  3. Karen Selwood3,
  4. Roderick Skinner4,
  5. Bob Phillips5,
  6. Julia C Chisholm6
  1. 1Division of Clinical Sciences, St George's, University of London, London, UK
  2. 2Great Ormond Street Hospital NHS Foundation Trust and London South Bank University, London, UK
  3. 3Oncology Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  4. 4Department of Paediatric and Adolescent Haematology/Oncology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  5. 5Centre for Reviews and Dissemination, University of York, York, UK
  6. 6Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
  1. Correspondence to Dr Jessica Bate, Division of Clinical Sciences, Paediatric Infectious Diseases Research Group, St. George's, University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London SW17 0RE, UK; jbate{at}sgul.ac.uk

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In September 2012, the National Institute for Clinical Excellence (NICE) published ‘Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients’.1 No national guidelines for the management of neutropenic sepsis in children have been previously published. In 2008, the Children's Cancer and Leukaemia Group produced a framework document for the treatment of febrile neutropenia (FN), based on a literature review and a Delphi survey.2 This document was designed to provide an evidence-based approach that could be used to inform local policies and to introduce risk stratification to inform FN management. It was produced in response to a survey suggesting wide variation in the definitions and management of FN.3

This reaudit aimed to ascertain whether the 2008 Children's Cancer and Leukaemia Group Framework Guideline forms standard unit policy in UK principal treatment centres, prior to the implementation of new NICE neutropenic sepsis guidance. A survey was sent by email to centre coordinators in each principal treatment centre in March 2012 with a request for local FN protocols.

Local FN protocols were received from 21/21 oncology centres and survey responses were received from 16/21 centres. Results presented are from survey responses with information supplemented from local protocols where incomplete data were provided. Of the centres surveyed, all manage children with FN as inpatients for the first 48 h. All units ensure good microbial resistance surveillance is in place and that results are regularly fed back into clinical practice. Table 1 shows the range of empirical antibiotic policies for FN, comparing results from the 2005 audit with the 2012 reaudit. Table 2 shows the main audit findings with current NICE guidance included for reference.

Table 1

Summary of empirical antibiotic policies for febrile neutropenia comparing results from the 2005 audit with the 2012 reaudit

Table 2

Summary of main audit findings with the new NICE guidance for reference

There continues to be variation in definitions for paediatric FN and its management with fewer than half of oncology centres using risk stratification to safely reduce the intensity and/or duration of therapy required in specific groups. The adoption of a national policy on neutropenic sepsis management based on the best available evidence of clinical effectiveness and cost-effectiveness will require local implementation but should improve outcomes of this potentially life-threatening complication of cancer treatment.

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Footnotes

  • Contributors JC, FG, KS and JB collated and analysed the data. JB wrote the paper and JC, FG, KS, BP and RS revised the manuscript critically.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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