{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:51:42Z","timestamp":1791305502662,"version":"4.3.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Maintaining broad-spectrum antibiotics until resolution of fever and recovery of absolute neutrophil count (ANC) has traditionally been the standard approach for pediatric patients with cancer and for hematopoietic stem-cell transplantation (HSCT) recipients who present with febrile neutropenia (FN). Recent studies in adults support the safety of discontinuing empiric antibiotic treatment (EAT) prior to ANC recovery. However, data in children remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective study that included patients under 18\u00a0years of age with cancer and\/or undergoing HSCT admitted with FN between June 2022 and August 2023, in whom EAT was discontinued prior to ANC \u2265500\/mm3. Patients already receiving antibiotics for a documented or suspected source of bacterial infection, sepsis, or admitted to pediatric intensive care unit (PICU) were excluded. We report the characteristics and clinical outcomes (readmission, new fever onset, and new infection) within 7\u00a0days of the discontinuation of EAT, as well as the 30-day PICU admission, infection-related mortality, and all-cause mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We included 97 episodes (65 patients) of FN, 47 (48.4%) occurred in children with hematologic disease (malignant or non-malignant), including patients who had received an HSCT (n\u2009=\u20098) and\/or a chimeric antigen receptors T-cell therapy (n\u2009=\u20096). Fever lasted less than 24\u00a0h in 75.3% of episodes. Median EAT duration was 3\u00a0days (interquartile range [IQR]: 3-5). Absolute neutrophil count recovery occurred at a median of 4\u00a0days (IQR 2-12) after EAT discontinuation. Fever recurred in 11 episodes (11.3%) within 7\u00a0days from EAT discontinuation. An infectious cause was identified in 3\/11 episodes (mild bacterial folliculitis, probable primary Cytomegalovirus infection, and invasive fungal infection, n\u2009=\u20091 each). No admissions to PICU or 30-day infection-related mortality were observed. Two patients died because of non-infectious causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early EAT discontinuation before ANC recovery in selected pediatric patients with FN, including high-risk patients, may reduce hospitalization and antibiotic exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jpids\/piag094","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:48:59Z","timestamp":1788954539000},"source":"Crossref","is-referenced-by-count":0,"title":["Early Discontinuation of Antibiotics in Pediatric Patients with Low- and High-Risk Febrile Neutropenia: A Single-Center Experience"],"prefix":"10.1093","volume":"15","author":[{"given":"Cristina","family":"C\u00e1mara Costa","sequence":"first","affiliation":[{"name":"Pediatric Department, Sant Joan de D\u00e9u Hospital Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ares","family":"Benavent Puiggen\u00e9","sequence":"additional","affiliation":[{"name":"Pediatric Department, Sant Joan de D\u00e9u Hospital Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Mas Malagarriga","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Sant Joan de D\u00e9u Hospital Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Antonia","family":"Ruiz-Cobo","sequence":"additional","affiliation":[{"name":"Oncology Department, Sant Joan de D\u00e9u Hospital Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mart\u00ednez-de-Albeniz","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Department , , Barcelona ,","place":["Spain"]},{"name":"Sant Joan de D\u00e9u Hospital Barcelona, Institut de Recerca Sant Joan de D\u00e9u , , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-5323","authenticated-orcid":false,"given":"Juli\u00e0","family":"Gotzens Bersch","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Department , , Barcelona ,","place":["Spain"]},{"name":"Sant Joan de D\u00e9u Hospital Barcelona, Institut de Recerca Sant Joan de D\u00e9u , , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Noguera-Julian","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Department , , Barcelona ,","place":["Spain"]},{"name":"Sant Joan de D\u00e9u Hospital Barcelona, Institut de Recerca Sant Joan de D\u00e9u , , Barcelona ,","place":["Spain"]},{"name":"Biomedical Research Network Center for Epidemiology and Public Health (CIBERESP) , Madrid ,","place":["Spain"]},{"name":"Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2115-1695","authenticated-orcid":false,"given":"Silvia","family":"Sim\u00f3 Nebot","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Department , , Barcelona ,","place":["Spain"]},{"name":"Sant Joan de D\u00e9u Hospital Barcelona, Institut de Recerca Sant Joan de D\u00e9u , , Barcelona ,","place":["Spain"]},{"name":"Biomedical Research Network Center for Epidemiology and Public Health (CIBERESP) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"2026100612003149800_ref1","doi-asserted-by":"publisher","first-page":"e270","DOI":"10.1016\/S1470-2045(20)30725-7","article-title":"8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation","volume":"22","author":"Lehrnbecher","year":"2021","journal-title":"Lancet Oncol"},{"key":"2026100612003149800_ref2","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.anpede.2023.03.010","article-title":"Consensus document on the management of febrile neutropenia in paediatric haematology and oncology patients of the Spanish Society of Pediatric Infectious Diseases (SEIP) and the Spanish Society of Pediatric Hematology and Oncology (SEHOP)","volume":"98","author":"Martinez Campos","year":"2023","journal-title":"An Pediatr (Engl Ed)"},{"key":"2026100612003149800_ref3","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1093\/cid\/cir073","article-title":"Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America","volume":"52","author":"Freifeld","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026100612003149800_ref4","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1200\/JCO.22.02224","article-title":"Guideline for the management of fever and neutropenia in pediatric patients with cancer and hematopoietic cell transplantation recipients: 2023 update","volume":"41","author":"Lehrnbecher","year":"2023","journal-title":"J Clin Oncol"},{"key":"2026100612003149800_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106171","article-title":"Safety of empirical antibiotic therapy discontinuing for fever of unknown origin during high-risk neutropenia in children","volume":"88","author":"Clement","year":"2024","journal-title":"J Inf Secur"},{"key":"2026100612003149800_ref6","first-page":"55","article-title":"Update on the management of febrile neutropenia in hematologic patients","volume":"32 Suppl 2","author":"Escrihuela-Vidal","year":"2019","journal-title":"Rev Esp Quimioter"},{"key":"2026100612003149800_ref7","doi-asserted-by":"publisher","first-page":"e02183","DOI":"10.1128\/AAC.02183-19","article-title":"Carbapenem-resistant gram-negative bacterial infections in children","volume":"64","author":"Aguilera-Alonso","year":"2020","journal-title":"Antimicrob Agents Chemother"},{"key":"2026100612003149800_ref8","doi-asserted-by":"publisher","first-page":"e573","DOI":"10.1016\/S2352-3026(17)30211-9","article-title":"Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 trial","volume":"4","author":"Aguilar-Guisado","year":"2017","journal-title":"Lancet Haematol"},{"key":"2026100612003149800_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012184.pub2","article-title":"Early discontinuation of antibiotics for febrile neutropenia versus continuation until neutropenia resolution in people with cancer","volume":"2019","author":"Stern","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026100612003149800_ref10","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1007\/s12098-020-03377-x","article-title":"Early discontinuation versus continuation of antimicrobial therapy in low risk Pediatric cancer patients with febrile neutropenia, before recovery of counts: a randomized controlled trial (DALFEN Study)","volume":"88","author":"Kumar","year":"2021","journal-title":"Indian J Pediatr"},{"key":"2026100612003149800_ref11","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/1471-2431-5-10","article-title":"Early discontinuation of intravenous antimicrobial therapy in pediatric oncology patients with febrile neutropenia","volume":"5","author":"Hodgson-Viden","year":"2005","journal-title":"BMC Pediatr"},{"key":"2026100612003149800_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103610","article-title":"Early stoppage of empirical antibiotic therapy in paediatric acute leukaemia with high-risk febrile neutropenia: a randomized, open-label, phase 3, non-inferiority trial","volume":"90","author":"Santosh","year":"2025","journal-title":"eClinicalMedicine"},{"key":"2026100612003149800_ref13","doi-asserted-by":"publisher","first-page":"778.e1","DOI":"10.1016\/j.jtct.2023.09.011","article-title":"Short-course empiric antibiotics in children undergoing allogeneic hematopoietic cell transplantation","volume":"29","author":"Patel","year":"2023","journal-title":"Transplant Cell Ther"},{"key":"2026100612003149800_ref14","author":"European Conference on Infections in Leukemia (ECIL)","year":"2024"},{"key":"2026100612003149800_ref15","doi-asserted-by":"publisher","first-page":"4427","DOI":"10.1200\/JCO.2012.42.7161","article-title":"International Pediatric fever and neutropenia guideline panel. Guideline for the management of fever and neutropenia in children with cancer and\/or undergoing hematopoietic stem-cell transplantation","volume":"30","author":"Lehrnbecher","year":"2012","journal-title":"J Clin Oncol"},{"key":"2026100612003149800_ref16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/00043426-200201000-00011","article-title":"Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer","volume":"24","author":"Alexander","year":"2002","journal-title":"J Pediatr Hematol Oncol"},{"key":"2026100612003149800_ref17","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1200\/OP.2025.21.10_suppl.469","article-title":"Global guidelines for febrile neutropenia management: a GRADE-based comparative analysis","volume":"21","author":"Warsame","year":"2025","journal-title":"JCO Oncol Pract"},{"key":"2026100612003149800_ref18","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.2147\/IDR.S238567","article-title":"Optimising antimicrobial selection and duration in the treatment of febrile neutropenia in children","volume":"Volume 14","author":"Morgan","year":"2021","journal-title":"Infect Drug Resist"},{"key":"2026100612003149800_ref19","doi-asserted-by":"publisher","first-page":"81","DOI":"10.6004\/jnccn.2020.0001","article-title":"Pediatric acute lymphoblastic leukemia, version 2.2020, NCCN clinical practice guidelines in oncology","volume":"18","author":"Brown","year":"2020","journal-title":"J Natl Compr Cancer Netw"},{"key":"2026100612003149800_ref20","doi-asserted-by":"publisher","first-page":"389","DOI":"10.7326\/M18-3192","article-title":"Management of patients with fever and neutropenia through the arc of time: a narrative review","volume":"170","author":"Pizzo","year":"2019","journal-title":"Ann Intern Med"},{"key":"2026100612003149800_ref21","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1056\/NEJM199909163411207","article-title":"Fever in immunocompromised patients","volume":"341","author":"Pizzo","year":"1999","journal-title":"N Engl J Med"},{"key":"2026100612003149800_ref22","doi-asserted-by":"publisher","DOI":"10.4084\/MJHID.2019.023","article-title":"Comparison of the power of procalcitonin and C-reactive protein to discriminate between different aetiologies of fever in prolonged profound neutropenia: a single-centre prospective observational study","volume":"11","author":"Verlinden","year":"2019","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"2026100612003149800_ref23","doi-asserted-by":"publisher","first-page":"857","DOI":"10.4067\/S0716-10182021000600857","article-title":"Management of episodes of febrile neutropenia in children with cancer. Consensus of the Latin American Society of Pediatric Infectious Diseases 2021","volume":"38","author":"Santolaya","year":"2021","journal-title":"Rev Chilena Infectol"},{"key":"2026100612003149800_ref24","doi-asserted-by":"publisher","first-page":"471","DOI":"10.3109\/00365548.2011.554855","article-title":"Elevated procalcitonin predicts gram-negative sepsis in haematological patients with febrile neutropenia","volume":"43","author":"Koivula","year":"2011","journal-title":"Scand J Infect Dis"},{"key":"2026100612003149800_ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0018886","article-title":"Monitoring procalcitonin in febrile neutropenia: what is its utility for initial diagnosis of infection and reassessment in persistent fever?","volume":"6","author":"Robinson","year":"2011","journal-title":"PLoS One"},{"key":"2026100612003149800_ref26","doi-asserted-by":"publisher","first-page":"S634","DOI":"10.1093\/ofid\/ofaa439.1413","article-title":"The role of procalcitonin (PCT) and lactic acid in febrile neutropenic cancer patients in an oncological emergency center","volume":"7","author":"Chaftari","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2026100612003149800_ref27","first-page":"643","article-title":"Diagnostic value of procalcitonin serum levels in comparison with C-reactive protein in allogeneic stem cell transplantation","volume":"87","author":"Hambach","year":"2002","journal-title":"Haematologica."}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpids\/advance-article-pdf\/doi\/10.1093\/jpids\/piag094\/71018829\/piag094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/15\/9\/piag094\/71018829\/piag094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/15\/9\/piag094\/71018829\/piag094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:00:37Z","timestamp":1791302437000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/doi\/10.1093\/jpids\/piag094\/8789921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":27,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,14]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piag094","relation":{},"ISSN":["2048-7207"],"issn-type":[{"value":"2048-7207","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,9]]},"article-number":"piag094"}}