Nate Nessle, DO

Nominated From: University of Michigan/Indiana University

Research Site: Kenya-Moi University

Research Area: Text Pediatric Hematology/Oncology

Primary Mentors: Dr. Terry Vik and Dr. Festus Njuguna

Research Project

The barriers and facilitators of effective management of febrile episodes in pediatric cancer patients

Febrile episodes, which may or may not be due to an infection, frequently complicate the clinical courses of pediatric cancer patients, who are at high risk for severe infections due to their immunocompromised status from cancer and subsequent chemotherapy. In sub-Saharan Africa, greater than 10% of kids with cancer with die from an infection compared to less than 0.5% in high-resourced settings, yet few patients have diagnostic blood cultures and prompt administration of antibiotics. This mixed methods, prospective cohort study aims to holistically describe febrile episodes in pediatric cancer patients with emphasis on the diagnostic and treatment approach of healthcare providers and the antibiotic resistance patterns of the bacterial isolates, providing the foundation to comprehensively improve the antibiotic recommendation and implementation of new treatment guidelines. We will prospectively follow pediatric cancer patients with febrile episodes who are admitted to Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya as they receive standard-of-care treatment for fevers. Clinical data from chart review will include characteristics and outcomes of the febrile episode as well as microbial data such as bacterial isolate and antibiotic resistance patterns. Semi-structured qualitative interviews will be conducted with healthcare providers in an exploratory manner to understand the barriers and facilitators of effective diagnosis and management of febrile episodes in kids with cancer. Study Objective: To improve our understanding of the diagnosis and treatment of febrile episodes in pediatric cancer patients by a holistic description of the clinical characteristics and the clinical approach to care delivery, serving as the foundation for the development of evidence based clinical guidelines and their successful clinical implementation. Aims: 1. Explore the barriers and facilitators of appropriate diagnosis and treatment of fevers in pediatric cancer patients at Moi Teaching and Referral Hospital 2. To describe the clinical characteristics and outcomes of the patients, and antibiotic resistance pattern of bacterial isolates of febrile episodes.

Research Significance

Treatment related mortality and multi-drug resistant bacterial infections in pediatric cancer patients in sub-Saharan Africa provide significant limitations for treatment teams. Pediatric oncologists must choose lower intensity chemotherapy treatment regimens and navigate significant, life threatening infections in their immunocompromised patients. This study takes a dual approach aimed at changing clinical practice to eliminate the discrepancy in infection-related mortality. The comprehensive clinical description of the febrile episodes, focusing on fever episode management and antibiotic resistance, will provide evidence for the development of a fever treatment guideline and recommendation for empiric antibiotics. Additionally, the qualitative assessment of barriers and facilitators of appropriate treatment from medical providers will serve as a foundational component in clinical implementation of the evidence-based fever treatment guideline and antibiotic administration. The collective, holistic description of the febrile episodes will not only allow for an impactful, clinical change of practice at MTRH, but will also provide a framework upon which other institutions in sub-Saharan Africa may build.

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