To investigate the effects of single-dose versus multiple-dose antimicrobial prophylaxis on surgical site infections (SSI) in patients undergoing elective surgery for rectal cancer

All patients received a preoperative bowel cleansing, kanamycin and erythromycin orally within 24 hours prior to surgery, and 1 g of a second-generation cephalosporin IV perioperatively. After surgery, patients were randomized to receive either single-dose prophylaxis one hour after surgery or an additional five doses over two consecutive days. Wounds were inspected daily in the hospital and in the clinic 30 days after surgery. The trial was designed to detect a 10% difference in the incidence of SSIs between groups.

• N = 279  
• MEAN AGE = 65 years (range = 33–91 years)
• MALES: 64.5%, FEMALES: 35.5%
• KEY DISEASE CHARACTERISTICS: All patients had rectal cancer; the majority had anterior resections
• OTHER KEY SAMPLE CHARACTERISTICS: None of the patients had preoperative chemotherapy or radiation therapy.

• SITE: Single-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

Noninferiority randomized, controlled trial

• SSIs were recorded according to Centers for Disease Control (CDC) definitions for incision site and organ/space infections

The incidence of incision site infections was 5% in the single-dose group and 7.1% in the multiple-dose group. Organ/space infections were 10.8% in the single-dose group and 8.6% in the multiple-dose group. Several organ/space infections were related to anastomotic dehiscence. Overall, the incidence of SSIs was 13.7% with single-dose prophylaxis and 13.6% with multiple-dose prophylaxis. Subgroup analysis by specific surgical procedure did not show any significant differences between groups.

Single-dose, postoperative, intravenous, antimicrobial prophylaxis demonstrated similar results to that of multiple-dose prophylaxis. Multiple antimicrobial doses did not show improved benefit for the prevention of surgical site infections

• Risk of bias (no blinding)

A single dose of IV antibiotic prophylaxis after rectal surgery for cancer had similar outcomes to that of multiple postoperative antibiotic doses. These findings show there is no benefit to more doses of prophylactic postoperative antibiotics for the prevention of SSIs.

Patients were assigned randomly to receive either placebo or interleukin-11 (IL-11) 50 mcg/kg/day subcutaneous (SC). The study drug was blinded. Randomization was stratified by investigative site and also by whether patients had received any prior chemotherapy. SC administration began on day two and was given for a minimum of 10 days after the first cycle of chemotherapy.

• N = 77     
• AGE: Older than 18 years of age
• WOMEN: 100%
• KEY DISEASE CHARACTERISTICS: Stage 2, 3, or 4 breast cancer and Eastern Cooperative Oncology Group (ECOG) status of 0–2
• OTHER KEY SAMPLE CHARACTERISTICS: Patients treated with cyclophosphamide (3200 mg/m²) and doxorubicin (75 mg/m²) IV on same day; chemotherapy repeated every 21–28 days

• Randomized, blind study

• The primary endpoint was whether a patient required platelet transfusions during two cycles of chemotherapy.
• Time to platelet recovery, open-label treatment, tumor response, time to neutrophil recovery, antibody development, safety, and efficacy

Sixty-seven patients were assessable. Sixty-eight percent of patients in the IL-11 group did not receive transfusions, versus 41% in the placebo group (p = .04). The IL-11 group had a decreased total number of platelet transfusions (p = .03) and time to platelet recovery to greater than 50K in the second cycle (p = .01). Side effects in the IL-11 group (p < .05) were peripheral edema (68%), dyspnea (48%), pleural effusion (18%), and conjunctival infection (25%).

• All female patients
• Only high-risk and advanced
• Well-controlled
• Did not demonstrate for dose intensity, maintenance of planned schedules
• Open-label so everyone could crossover
• Did not address how people stayed on track for schedule
• IL-11 for first two cycles
• How many women went on to get planned schedules?
• Where was the science in 1997?

To examine the effects of an exercise intervention on the severity of aromatase inhibitor (AI)-induced arthralgia in women with breast cancer

Patients were randomly assigned to a year-long exercise program consisting of twice weekly supervised resistance training and home-based aerobic exercise for 150 minutes per week. Participants wore heart rate monitors during workouts, and after each exercise session, participants recorded exercise type, duration, and average heart rate in logs. The aerobic component was usually brisk walking although patients could choose other activities such as stationary bike use. Strength training consisted of six exercises with gradually increasing weight. Women in the usual care group were instructed to continue usual activities. Those in the usual care group received monthly phone calls to determine AI adherence. 

• N = 107 (completed six months), 24 (completed 12 months)
• MEAN AGE = 61.3 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had breast cancer and were receiving AIs; 60% had stage 1 disease 
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of participants were Caucasian (88%). Women who were physically active were excluded.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: New England, United States

• PHASE OF CARE: Late effects and survivorship

Randomized, controlled trial

• Brief Pain Inventory (BPI)
• Western Ontario and McMaster Universities Osteoarthritis Index (WOMUOI)
• Disabilities of the Arm Shoulder and Hand (DASH) questionnaire 
• Grip strength 

Women assigned to exercise increased their physical activity by an average of 159 minutes per week compared to an average of 49 minutes per week in the usual care group (p < 0.001). Over 12 months, worst joint pain decreased by 29% in the exercise group while usual care patients showed a 3% increase (p < 0.001). The same patterns were shown in the DASH and osteoarthritis index measures. There was no dose response from exercise effects on arthralgia pain or functional measures. Adherence to AIs was 76% in the usual care group and 80% in the exercise group. AI-associated joint pain worsened slightly over time in the usual care group. The strongest benefit of exercise was seen after 12 months.

The findings of this study suggested that an exercise program including aerobic, resistance, and strength training may reduce pain from arthralgia caused by AIs among women with breast cancer.

• Small sample (< 30)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: More patients in the usual care group did not complete the study.

Exercise has been recommended for patients with cancer to ameliorate multiple symptoms. This study showed that exercise also can reduce arthralgia-related pain associated with AIs and improve function among breast cancer survivors. Nurses can educate patients regarding the numerous benefits of exercise and can encourage and recommend regular exercise.

Compare the efficacy of 3 drugs in preventing hot flashes in men receiving  hormone treatment for prostate cancer

Patients were randomly assigned to receive wither venlafaxine delayed release 75 mg/day, medroxyprogesterone 20 mg/day or cyproterone acetate 100 mg/day in addition to leuprorelin injections.  Patients were followed up at 4, 8 and 12 weeks.  Patients completed daily hot flush diaries and categorised hot flush severity

• N  309 AGE   Not reported
• MALES (%) 100%         FEMALES (%)
• KEY DISEASE CHARACTERISTICS All had prostate cancer treated with hormonal therapy for at least 6 months.  All had experienced 14 or more hot flushes in the week before study entry

 Double blind randomized controlled trial

• Daily hot flush diary
• European Organization for Research and Treatment of Cancer Quality of life questionnaire ( EORTC-QLC 30)
   

Patients in the medroxyprogesterone group had higher hot flash scores at baseline.  The reduction in daily hot flush scores at 4 weeks was significantly lower for all 3 groups (p<.0001).  Improvements were significantly lower in the venlafaxine group than either of the other 2 groups ( p = .0006), and patients ratings of efficacy of treatment showed that significantly fewer patients in the venlafaxine group rated the treatment as good ( p<.0001) compared to the other 2 groups. Adverse events related to the study drugs were not significantly different between groups, though cyproterone led to a non significantly higher number of vascular adverse events.  The most frequent adverse events were gastrointestinal, including pain, constipation, diarrhea and nausea.  GI events were more frequent with venlafaxine.

Men with significant hot flushes during androgen suppression for prostate cancer appeared to respond better to cyproterone acetate and medroxyprogesterone acetate than to venlafaxine

• Baseline sample/group differences of import
• Risk of bias (no control group)
• Other limitations/*explanation  No control or placebo group precluded observation of placebo effect.  The sample was limited to patients who sought treatment for hot flashes.  This was a short follow up period - longer term efficacy is not known. Effects of hormonal treatment for hot flashes on prostate cancer are not known.

It appears that hormonal treatment is more effective in than venlafaxine for management of hot flashes in patients who are receiving androgen suppression for prostate cancer.  Results also showed that many men did not seek treatment for this problem, suggesting that nurses may need to directly assess these patients for problems with hot flash symptoms.  Effects of steroidal anti androgens on prostate cancer are not clear, and patients receiving both androgen suppression and cyproterone or medroxyprogesterone could have increases in prostate specific antigen concentrations.

To review the evidence regarding evaluation and management of patients with peripheral lymphedema

This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based on modifications that were

• Suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, which were discussed at the 1999 XVII ICL in Chennai, India, and considered and confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany.
• Derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy, as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina.
• From suggestions, comments, criticisms, and rebuttals as published in the December 2004 issue of Lymphology.
• Suggested from discussions from both the 2005 XX ICL in Salvador, Brazil, and the 2007 XXI ICL in Shanghai, China, as modified at the 2008 Executive Committee Meeting in Naples, Italy.

Search strategy was not provided.

The consensus included the following components.

• General considerations: Because lymphedema is a chronic, generally incurable ailment, it generally requires, as do other chronic disorders, lifelong care and attention along with psychosocial support. The compliance and commitment of the patient also is essential to an improved outcome.
• Staging of lymphedema: The current lymphedema stages (Stage O, Stage I, Stage II, and Stage III) only refer to the physical condition of the extremities. A more detailed and inclusive classification needs to be formulated in accordance with improved understanding of the pathogenetic mechanisms of lymphedema (e.g., nature and degree of lymphangiodysplasia, lymph flow perturbations and nodal dysfunction as defined by anatomic features and physiologic imaging and testing) and underlying genetic disturbances. Recent publications incorporating both physical (phenotypic) findings with functional imaging into a combined staging may be forecasting the future changes in staging.
• Diagnosis: The diagnosis of lymphedema can be readily determined from the clinical history and physical examination. A thorough medical evaluation is indispensable before embarking on lymphedema treatment.
  • Imaging: If the diagnosis of lymphedema is unclear or in need of better definition for prognostic considerations, consultation with a clinical lymphologist or referral to a lymphologic center if accessible is recommended. The diagnostic tool of isotope lymphography (also termed lymphoscintigraphy or lymphangioscintigraphy) has proved extremely useful for depicting the specific lymphatic abnormality.
  • Genetic testing is almost becoming practical to define a limited number of specific hereditary syndromes with discrete gene mutations such as lymphedemadistichiasis (FOXC2), some forms of Milroy disease (VEGFR-3), and hypotrichosislymphedema-telangiectasis (SOX18).
  • Biopsy: Caution should be exercised before removing enlarged regional lymph nodes in the setting of longstanding peripheral lymphedema as the histologic information is seldom helpful and such excision may aggravate distal swelling.
• Treatment: Therapy of peripheral lymphedema is divided into conservative (nonoperative) and operative methods.
  • Meticulous skin hygiene and care (e.g., cleansing, low pH lotions, emollients) is of importance to the success of virtually all treatment approaches.
  • Basic range of motion exercise of the extremities combined with external limb compression and limb elevation are also helpful to virtually all patients undergoing treatment. As previously stated, even widely used methods have yet to undergo sufficient meta-analysis of multiple studies, which have been rigorous, well-controlled, and with sufficient follow-up.

The following Research Agenda has been proposed.

• Ongoing epidemiologic studies on the incidence and prevalence of lymphedema regionally and worldwide need to be conducted.
• Assessment of lymphedema risk and steps for lymphedema prevention in different groups of at-risk patients need to be determined. Studies might include research on minimizing or preventing secondary lymphedema through altered operative or sampling techniques (e.g., sentinel node biopsy, precise anatomical knowledge of derivative pathways), vector control (as demonstrated in China) and prophylactic drugs for filariasis, identification of patients with heritable genetic defects for lymphangiodysplasia (lymphedema), and use of massage or compression where lymphatic drainage is subclinically impaired as documented by imaging techniques.  
• Research in molecular lymphology, including lymphatic system genomics and proteomics, should be encouraged. With the cellular and molecular basis of lymphedema-associated syndromes better defined, an array of specificbiologically based treatments, including modulators of lymphatic growth and function, should become available.  
• Improved imaging techniques and physiological testing need to be devised to allow more precise noninvasive methods to measure lymph flow dynamics and lymphangion activity. Continuous improvement is needed in imaging techniques as well as in the development of new technologies (e.g., near infrared) to visualize the superficial and deep lymphatic system.  
• As knowledge accrues, the current crude classification of lymphedema should be revisited and modified to include a more encompassing clinical description based on genetic, anatomic, and functional disability.
• Accordingly, treatment, whether by designer drugs, gene or stem cell therapy, tissue engineering, physical methods, or new operative approaches, should be directed at preventing, reversing, or ameliorating the specific lymphatic defect and restoring function and quality of life.

Lymphedema may be simple or complex but should not be neglected. Accurate diagnosis and effective therapy is now available, and lymphology itself is now recognized as an important specialty in which clinicians are carefully trained in the intricacies of the lymphatic system, lymph circulation, and related disorders. The emerging era of molecular lymphology should result in improved understanding, evaluation, and treatment in clinical lymphology. Limited evidence exists regarding treatment. Basic recommendations are meticulous skin hygiene and care and range of motion exercise with compression. This document provides extensive information on the state of knowledge and areas for future research in lymphedema prevention and management.

To assess compliance with chemotherapy-induced nausea and vomiting (CINV) guidelines and effects on patient outcomes

Patients were assessed for early and delayed CINV using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT). Chemotherapy and anti-emetic agents used were extracted from medical records, along with MAT results. Comparison was made between agents used and current practice guidelines used in the organization. Guidelines were dexamethasone for lowly emetogenic chemotherapy (LEC), either triple drug or doublet antiemetics for moderately emetogenic chemotherapy (MEC), and triple drug antiemetics for highly emetogenic chemotherapy (HEC).

• N = 73   
• MEDIAN AGE = 62 years
• AGE RANGE = 28-79 years
• MALES: 49.3%, FEMALES: 49.7%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Varied tumor types; colorectal, breast, and lung were most common.
• OTHER KEY SAMPLE CHARACTERISTICS: About 50% were on LEC, 23% on MEC, and 15% on LEC.

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: Japan

PHASE OF CARE: Active antitumor treatment

Retrospective cohort

• MASCC MAT
• Complete response (not defined)

Overall compliance with guidelines was 87.7%-98.6% for early phase CINV prophylaxis and 87% for delayed phase. Delayed phase compliance with LEC was 97.4%, with MEC was 82.4%, and with HEC was 54.5%. In the LEC group, CINV was not prevented in 11.3%, where guidelines were used, and 29% in the undertreated group. In the MEC group, it was not prevented in 11.8% with guidelines and 14.3% in the undertreated group. In the HEC group, CINV was not prevented in 45.5% with guidelines and 50% in the undertreated group.

Adherence to CINV prophylaxis guidelines was associated with better CINV prevention compared to undertreated patients; however, adherence to HEC guidelines was low, adherence was particularly low for delayed phase prevention, and guidelines based on emetogenicity of chemotherapy alone appear to be insufficient for CINV prophylaxis, particularly with HEC regimens.

• Small sample (< 100)
• Risk of bias (no random assignment)
• Key sample group differences that could influence results
• Measurement/methods not well described
• Other risk factors not described or used in analysis
• Reports CINV grade but no mention of grading measure used.
• The authors stated that HEC guidelines were effective; however, 45% in whom guidelines were followed had lack of CINV control.

The findings suggest that following professional CINV prophylaxis guidelines may be helpful for CINV control, although insufficient for control with HEC chemotherapy. Adherence to preventive guidelines for delayed phase CINV and HEC appears to be more problematic. Guideline adherence alone based on emetogenicity of chemotherapy appears to be insufficient to achieve complete control of CINV. Nurses need to advocate for consideration of individual risk factors in planning CINV prevention and ensure care planning for delayed phase interventions. Lack of delayed phase effectiveness also points to the need to ensure that patients have medication for any breakthrough CINV and that patients are adherent to medication regimens for prevention.

To determine the feasibility of administering a flavonoid-rich adjunctive treatment (Concord grape juice) for the management of chemotherapy-induced nausea and vomiting (CINV)

Eligible patients were randomized to either the experimental group, which received Concord grape juice, or the control group, which received a placebo composed of water, sweeteners, food-grade acids, natural grape essence, and food coloring (but no fruit juice).

Both groups drank 4 oz. of the grape juice or placebo beginning the evening of the treatment day and 30 minutes prior to meals for seven days following each of four chemotherapy treatments; an additional 4 oz. could be taken as needed for nausea. All patients received standard medical management of CINV.

• The sample consisted of 77 participants.
• In the experimental group, the median age was 54.1 years (SD = 12.4 years); in the control group, the median age was 54.5 years (SD 12.7).
• The experimental group was 80% female, and the control group was 81% female.
• Diagnoses included breast (70%), lung cancer (6%), lymphoma (6%), non-Hodgkin lymphoma (NHL) (5%), colon (3%), and prostate (3%).

The study was conducted at a single outpatient setting in northeastern United States.

All patients were in active treatment.

This pilot study was a double-blind, randomized clinical trial.

• Patients recorded the amount of grape juice or placebo consumed and usual and weekly food intake in daily logs.
• Patients measured CINV daily using the Rhodes’ Revised Index of Nausea and Vomiting (INV-R).
• They also used the Multiple Affect Adjective Checklist, Revised (MAACL-R) and the 16-item McGill Quality-of-Life Questionnaire (MQOL).
• A self-report instrument using a Likert-type format was used to measure perceived control over decision making at baseline and the cancer treatment experience at the end of the data collection period.

• Nausea and vomiting frequency, duration, and distress were lower for experimental group members, although a high attrition rate (50%) resulted in insufficient power to detect statistically significant differences over time.
• Dropout rates suggested that the intervention was undesirable or participation in the study was too much of a burden.
• A few participants commented on the sweetness of the juice or placebo which they reported was difficult to drink when nauseated.
• Greater levels of anxiety, depression, and hostility at baseline were related to nausea and vomiting, quality of life, and perceived control over decision making.

This study did not show any benefit of grape juice flavonoids for management of CINV.

• The sample was small sample, with fewer than 100 participants.
• Initial analyses of clinical outcomes showed some differences over time; however, because of the limited sample size and the attrition rate, statistically significant differences were not seen for the majority of outcomes.
• The reliance of the self-report measures may have contributed to over- or underreporting of symptoms.

The effect of grape juice flavonoids on CINV should be investigated further with a larger sample to determine whether preliminary findings are supported. Use may be limited because of intolerance of very sweet juice.

To provide guidelines for antimicrobial prophylaxis and management of febrile neutropenia (FN) for adult outpatients with neuropathy.

The resource was a consensus-based guideline. A literature search examined articles indexed in MEDLINE (January 1987–April 2011).  A systematic review of 47 articles from 43 studies were included in the analysis. Keywords included terms for malignant diseases; terms for neutropenia, infection, or fever; and terms for clinical guidelines, systematic reviews, meta-analyses, or clinical trials.

Articles were included if they were fully published English language reports on the topics of antimicrobials for the prevention of infection in neutropenic outpatient patients with cancer (with or without fever), direct comparisons of outcomes between inpatient and outpatient management of FN in patients with cancer, and methods to quantify risk of complications in patients with cancer and FN. Articles were excluded if they were meeting abstracts, commentaries, letters, editorials, case reports, and nonsystematic reviews.

Patients were undergoing the active treatment phase of care.

A table of recommendations addressed three main areas of concern: (a) preventing infection in patients at risk for neutropenia undergoing chemotherapy, (b) identifying which patients with cancer and FN may be safely treated as outpatients, and (c) identifying interventions for the outpatient management of FN.

• Patients should be systematically assessed for risk of FN and/or need for granulocyte colony-stimulating factor prophylaxis.
• Antimicrobial prophylaxis is recommended only if neutropenia is expected to be profound (absolute neutrophil count [ANC] <100) and more than seven days in duration.
• Annual influenza immunization is recommended for all patients undergoing chemotherapy and their family members.
• Drugs of choice are an oral fluoroquinolone for antibacterial prophylaxis and an oral triazole for antifungal prophylaxis.
• Patients with FN should be assessed using the Multinational Association for Supportive Care in Cancer (MASCC) score or Talcott’s rules to guide whether outpatient treatment is safe. In addition, patients should be compliant, live near the hospital, and have a caregiver and access to transportation at all times.
• If treating FN as an outpatient, it is recommended to begin empiric antimicrobial treatment within one hour and observe for four hours.
• Drugs of choice for outpatient empiric treatment of FN are an oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin for those allergic to penicillin).

• Limited data exist from randomized, controlled trials regarding health outcomes or comparing the efficacy and safety of alternative regimens of antimicrobial prophylaxis.
• The MASCC score revealed a high rate of false-positive results.

These guidelines help clinicians determine which patients require hospitalization and which can safely be treated in the outpatient setting. The guidelines also aid in selecting appropriate antimicrobial prophylaxis for neutropenic patients.

The purpose of the study was to compare effects of two different doses of G-CSF in pediatric patients receiving high-dose chemotherapy.

Patients receiving induction chemotherapy were randomly assigned to receive either 5 mcg/kg or 10 mc/kg G-CSF daily after the first and second chemotherapy induction courses. Differences in number of neutropenic days, hospital days, number of febrile neutropenic episodes, episodes of infection, use of IV antibiotics, antifungal therapy courses, number of transfusions, cost of supportive care, and estimates of event-free survival.

• 46 total participants
• Median age was 9.03 years, with a range of 0.05–21 years.
• Females made up 53% of the sample; males made up 47% of the sample
• All participants had previously untreated AML or myelodyplastic syndrome and were receiving induction chemotherapy.
• Specific chemotherapy protocol used is described.
   

Single-site inpatient location

The phase of care was active antitumor treatment.

The application was for pediatrics.

Double-blind, randomized, controlled trial

• NCI Common Toxicity Criteria [v.2.0]
• Neutropenia was defined as a neutrophil count of less than 0.5 x 10⁹/L
• Event-free survival was defined as time between randomization and disease recurrence, death, secondary malignancy, or last follow-up.
   

No significant differences were noted between study groups in number of neutropenic days, episodes of febrile neutropenia, days of hospitalization, episode of antibiotic and antifungal therapy, transfusions, or cost of supportive care. There was no difference between groups in proportion of complete responses, or estimates of event-free and overall survival.

No difference was noted in measured outcomes between groups of patients treated with two different doses of G-CSF.

• Small sample (less than 100 participants)
• It is unclear if patients were given prophylactic antibiotics or antifungal therapy, which would have affected related outcomes. Sample included both patients who did and did not receive allogeneic stem cell transplantation.

Findings suggest that lower daily doses of prophylactic G-CSF can be as effective as higher doses in pediatric patients during induction chemotherapy. Dosage and timing of prophylactic G-CSF is not fully clear.

To examine the effects of antibiotic prophylaxis on bacterial infections, antibiotic sensitivity, and nasal and rectal culture findings

Prophylaxis was outpatient administration of antibacterials after myelosuppressive therapy and the onset of an absolute neutrophil count ≤ 0.5 x 10⁹/L in the absence of fever or other indicators of infection. Prophylaxis was discontinued when the neutrophil count exceeded 0.1 x 10⁹/L. All patients were on a study protocol in which the prophylactic regimens used were amended on an ongoing basis based on short-term findings. In general, patients received IV cefepime every 12 hours, or vancomycin every 12 hours with oral cephalosporin, oral ciprofloxacin, or IV cefepime. All patients received antifungal prophylaxis with voriconazole or echinocandin, pneumocystis prophylaxis, and did not receive colony-stimulating factors. Patients were trained to administer the IV antibiotics. Patients who presented with neutropenia and fever were admitted and treated empirically. Patients had surveillance cultures of the nares and rectum at each admission for detection of resistant organisms. Patients were grouped according to the type of prophylaxis received: A: oral cephalosporin only, B: protocol as described.

• N = 103 
• AGE RANGE = 1–21 years, 46% were 10–21 years
• MEDIAN AGE: 8.7 years
• MALES: 52.4%, FEMALES: 47.5%
• KEY DISEASE CHARACTERISTICS: All had acute myeloid leukemia (AML)
• OTHER KEY SAMPLE CHARACTERISTICS: 73% were Caucasian, 23% African American

• SITE: Single site  
• SETTING TYPE: Multiple settings  
• LOCATION: St. Judes Hospital

• PHASE OF CARE: Active antitumor treatment

• Retrospective analysis of a previous prospective trial

• Infection and febrile neutropenia defined by the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) 3.0
• Fever–oral temperature of 38º C persisting for one hour, or single oral temperature of 38.3º C
• Blood stream infection as defined by Centers for Disease Control and Prevention criteria

Most common infectious events were neutropenia with fever of unknown origin; bloodstream infections; and infections of the skin/mucosa, GI tract, and upper respiratory tract. There was no difference between groups in episodes of fever of unknown origin. Patients who received the full prophylaxis protocol had significantly fewer infectious episodes of any type during induction 1 (p = 0.002), induction 2 (p = 0.0002), and consolidation (p = 0.001). Patients receiving the full vancomycin-based regimen had higher incidence of vancomycin-resistant enterococci (VRE) isolates from surveillance, and three cases also had VRE bacteremia.

Outpatient IV antibiotic prophylaxis was feasible and reduced the incidence of documented infection and bacteremia. Patients receiving vancomycin-based prophylaxis had lower rates of infectious events and had higher incidence of VRE isolates from surveillance.

• Risk of bias (no random assignment)

This study showed that provision of outpatient IV antibiotic prophylaxis to children, administered by their parents, was feasible and effective in reducing infectious events. Findings point to the ongoing need for managing the intensity and duration of prophylaxis to minimize development of resistant bacterial strains.