The Methodology and Outcomes of Adapting an Antibiotic Selection Decision Pathway (ASDPwy) for the Management of a Child with Cancer and Fever (CCF) in Pediatric Cancer Units in Latin America

Abstract

Abstract Background A care pathway (CPW) is a standardized, evidence-based interdisciplinary care management plan, which identify an appropriate sequence of clinical interventions, timeframes, milestones and expected outcomes for a comparable patient group. We aimed to adapt an ASDPwy for management of CCF in Latin America (LA) Methods A working group (WG) of the St Jude Global ID network was established in June 2022. For a comprehensive review of the existing literature, the WG collaborated to identify usable care pathways for antibiotic selection during febrile episodes in children with cancer. We reviewed PubMed, Web of Science, Google were searched using the following terms: “Care Pathways, Critical Pathways Care Map, Clinical Paths, Clinical Pathways, Critical Paths” AND “Fever” OR "Anti-Inflammatory Agents" OR "Anti-Inflammatory Agents, “Non-Steroidal" OR "Heat-Shock Proteins" OR "Hyperthermia, Induced" OR "Malignant Hyperthermia" OR Pyrogens AND infections AND neutropenia OR neutrophil* AND cancer OR oncology OR tumor OR tumor OR neoplasm OR malignancy, filtered for the last 10 years, in individuals aged birth-18 years. To identify suitable care pathways, a rubric using available information was built and used to select the top CPWs. In a dedicated, virtual meeting, the WG discussed and selected top 3 CPW and the WG assessed how these CPWs could be use in a LA context. This discussion resulted in the selection of a CPW closest to the needs of LA, adapt and contextualize to LA reality. This was done by the following steps, based on Dizon [ref] and Ferver [ref] models. Results The WG followed the following timeline of events: The WG presented the ASDPwy as illustrated below Conclusion This is the first adaptation of a ASDPwy in CCF in LA. The next step before applying this ASDPwy is to evaluate the performance of the tool and the satisfaction of the users. The long-term plan is to disseminate the use of this tool in the Latin American region and if applicable share it globally.