The new guidelines place greater emphasis on antimicrobial stewardship and infection prevention.
The Australasian consensus guidelines for the management of neutropenic fever in patients with cancer have been updated for the first time since 2011.
Neutropenic fever is the leading infectious complication in patients receiving systemic chemotherapy. The national consensus guidelines for the management of NF were published in 2011, making them well overdue for an update. Now, a group of dedicated clinicians have updated and expanded principles and practices contained within the guidelines. The full version is freely available, published in a special issue of the Internal Medicine Journal.
“These guidelines reflect the new treatment paradigms for cancer care (such as immunotherapy, bispecific antibodies, oral targeted therapies and CAR T) given the changing risks of NF and sepsis, the emerging challenges of antimicrobial resistance and the new models of care for managing NF,” the authorship group wrote.
“Institutions should consider a systems-wide approach to implementing NF and sepsis guidelines and ensure that there is appropriate engagement of clinical teams across the organisation, including for antimicrobial stewardship and infection prevention.”
A 14-person steering committee was assembled to oversee the development of the new guidelines, consisting of adult and paediatric specialists from Australia and New Zealand. The steering committee was made up of infectious diseases clinicians – including physicians, nurse practitioners and pharmacists – along with haematologists, oncologists and a consumer.
The first step in developing the new guidelines was to repeat a clinical practice survey to capture the attitudes and practices of various specialists on the management of NF. The 130-odd responses to the survey revealed that although practices had evolved and updated since the 2011 version of the guidelines, there were important gaps in areas such as risk assessment, the potential for early discharge and antimicrobial stewardship. The findings from this survey helped guide the review and writing process for the new guidelines.
“The intended audience for these guidelines is clinicians caring for patients with underlying haematological or solid organ malignancy, including infectious diseases physicians, haematologists, oncologists, general physicians, nurses, specialist nurses and trainees practicing in Australia and New Zealand,” the guideline authors said.
As part of the drafting process, the following professional societies were given the opportunity to review each updated guideline: the Australasian Society for Infectious Diseases, the Australian Society for Antimicrobials, the Australasian Leukaemia and Lymphoma Group, the Australian and New Zealand Children’s Haematology/Oncology Group, the Australia and New Zealand Transplant and Cellular Therapies Group, the Clinical Oncology Society of Australia, the Medical Oncology Group of Australia, the Haematology Society of Australia and New Zealand, Private Cancer Physicians of Australia and Advanced Pharmacy Australia. Where appropriate, feedback from these groups was incorporated into the documents.
The various sections of the guidelines’ focus include best practice tips for antimicrobial stewardship and infection prevention, the initial management of NF, managing NF after empiric therapy or during ambulatory care and patient and carer education about NF.
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“The scope of these guidelines has been broadened to include paediatrics for the first time and now includes considerations for New Zealand practice,” the authorship group noted. “Further, new chapters are dedicated to antimicrobial stewardship and infection prevention and patient and carer education.”
“Recognising the longstanding challenges about decision-making in the setting of recurrent or persistent NF, a new chapter provides guidance about antimicrobial management and investigations.”
The authorship group emphasised the need for a systems-wide approach to infection prevention and management in cancer patients, as these individuals can present across different areas of the healthcare environment.
“A multidisciplinary approach ensures that stakeholders from these areas are engaged in the implementation of guidelines and pathways for NF. Importantly, about 50% of NF patients will present with sepsis and should be managed according to the local sepsis programme,” they wrote.
