Biology of Blood and Marrow Transplantation | 2019
The Effectiveness of the Neutropenic Diet in Pediatric Bone Marrow Transplant Patients
Abstract
Background Opportunistic infections are a significant cause of morbidity and mortality in children treated with chemotherapy. Historically, the neutropenic diet has been utilized to limit the incidence of infections by reducing exposure to potential pathogens. The neutropenic diet is utilized at our center for all allogeneic(allo) hematopoietic stem cell transplant (HSCT) patients at admission and restricts uncooked vegetables, fruits without thick peels, undercooked meats/seafood, and any restaurant food. Autologous (auto) HSCT patients follow a regular diet with food safety education according to Center for Disease Control (CDC) and Food and Drug Administration (FDA). The neutropenic diet is not endorsed by the CDC and FDA due to lack of evidence to support it. We hypothesize the neutropenic diet offers limited advantage over the FDA and CDC food safety guidelines in respect to rates of neutropenic fever or infection. Methods We performed a retrospective descriptive review of consecutive pediatric patients >1 year of age that underwent HSCT between June 2016 and February 2017 to assess fever and infectious complications occurring before engraftment. All patients were placed on prophylactic antibiotic therapy (cipro and pen VK) on admission until fever or engraftment. Results A total of 72 HSCT procedures were conducted on our inpatient unit (Auto, 24 and Allo 48). Median age at HSCT was 6 years (Range 1-24 years). Of 72 total transplants, 56 (78%) had at least one fever episode from the start of conditioning until engraftment. The median day of fever was day -2. 6 of 57 episodes of fever were due to blood steam infection (3 allogeneic; 3 autologous), Organisms included Bacillus species, Enterobacter cloacae, acid fast bacilli, Streptococcus oralis and Staph epidermidis. Twenty-eight patients had diarrhea, five had identified stool pathogens to include C.difficile (n=2), Adenovirus (n=3), Norovirus (n=1), E.coli (N=1), of note 2 patients had 2 concurrent infections present. Sixty seven(89%) patients received TPN for a median of 41 days (ranging from 9-233 days) for allogeneic and median of 20 days (ranging from 6-170 days) for autologous recipients. Thirty seven (49%) patients had clinically documented mucositis (see Table 1). Discussion Fevers were commonly chemotherapy related and infectious causes were rare for both auto HSCT on a regular diet and allo HSCT on a neutropenic diet. Antibiotic practices may contribute to outcomes. Further investigation evaluating the safety of the FDA diet during the neutropenic period of HSCT is warranted to improve overall nutrition and quality of life.