From the Guidelines
Pediatric oncology patients are indeed at a significant risk for infectious complications due to intensive chemotherapy regimens resulting in prolonged immune suppression. This risk is highlighted in a recent guideline for antibacterial prophylaxis administration in pediatric cancer and hematopoietic stem cell transplantation, published in 2020 1. Chemotherapy drugs directly suppress bone marrow function, leading to neutropenia, which impairs the body's ability to fight infections. The highest risk is typically experienced when the absolute neutrophil count falls below 500 cells/mm³, especially during periods of prolonged neutropenia lasting more than 7 days.
Common Infectious Complications
Common infectious complications in these patients include:
- Bacterial infections, particularly gram-negative organisms like Pseudomonas and Escherichia coli
- Fungal infections, such as Candida and Aspergillus
- Viral infections, including herpes simplex virus and cytomegalovirus
Preventive Measures
Preventive measures often include antimicrobial prophylaxis with medications like:
- Trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia prevention
- Fluconazole for fungal prophylaxis
- Acyclovir for herpes virus prevention
Management of Fever
Additionally, these patients require prompt evaluation for fever (temperature ≥38.3°C once or ≥38.0°C for over an hour), which typically includes blood cultures and broad-spectrum antibiotics like piperacillin-tazobactam or cefepime, as emphasized in the 2024 guidelines for prevention and treatment of cancer-related infections 1. The immune suppression results not only from direct effects on white blood cells but also from disruption of mucosal barriers in the gastrointestinal tract, allowing for bacterial translocation, and impairment of cell-mediated immunity, which increases susceptibility to opportunistic pathogens. Therefore, individualized risk evaluation for infections, incorporation of preventative measures, and prompt identification and treatment of active infections are essential components of the overall spectrum of care in cancer management.
From the Research
Infectious Complications in Pediatric Oncology Patients
- Pediatric oncology patients are at risk for infectious complications due to intensive chemotherapy regimens resulting in prolonged immune suppression 2, 3.
- The use of total parenteral nutrition (TPN) in pediatric oncology patients has been associated with high infection rates and metabolic problems 4.
- Pneumocystis jirovecii pneumonia (PJP) is a significant opportunistic infection in immunocompromised patients, including pediatric oncology patients 2, 5, 6.
Risk Factors for Infectious Complications
- Neutropenia is a common reason for switching to alternative prophylaxis therapy in pediatric oncology patients 2.
- The intensity and toxicity of cancer treatment can lead to decompensation and the need for admission to the pediatric intensive care unit (PICU) 3.
- The use of TPN may enhance tumor cell growth, and its use should be carefully considered in pediatric oncology patients 4.
Prevention and Treatment of Infectious Complications
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used prophylactic agent for PJP in pediatric oncology patients 2, 5, 6.
- Low-dose TMP-SMX regimens may be effective in preventing PJP while reducing adverse reactions and mortality rates 5, 6.
- Further studies are needed to compare the efficacy of different prophylaxis regimens and to optimize dosing strategies for TMP-SMX in pediatric oncology patients 2, 6.