DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS ⚠️ Small Study / Early Comparative Evidence
Among 172 CAYA (under 24 years) undergoing haplo-HCT at St. Jude from 2010–2022, a 2017 institutional guideline recommending antibiotic discontinuation within 72 hours of febrile neutropenia regardless of persistent fever was compared against prior standard-of-care continuation until engraftment.
Clinical Considerations
- Post-implementation patients (n=82) had a median 8 fewer days of antibiotic therapy vs. pre-implementation (n=90); 14 fewer days when prophylaxis was included.
- BSI rates trended higher post-implementation (13.4% vs. 6.7%) but did not reach statistical significance; the study was underpowered to detect smaller clinically meaningful differences.
- Two-thirds of post-implementation BSIs involved cefepime-resistant organisms, suggesting continued empiric therapy would not have prevented them.
- DOOR–modified RADAR analysis showed 70% probability of more favorable outcomes in the post-implementation group after integrating antibiotic exposure with clinical outcomes.
Practice Applications
- Consider 72-hour empiric antibiotic discontinuation in clinically stable haplo-HCT recipients with febrile neutropenia and no identified infection, consistent with this institutional protocol.
- Recognize that persistent fever alone, without instability or confirmed infection, may not justify continued broad-spectrum coverage in this population.
- Monitor BSI rates carefully if adopting early discontinuation; the numerically higher post-implementation BSI rate warrants ongoing surveillance.
- Interpret cautiously: single-center, retrospective design with moderate guideline fidelity (68%) limits generalizability pending multicenter trial confirmation.
