BackgroundTwo approaches are used to manage invasive fungal disease (IFD) in febrile neutropenic patients viz. empirical therapy (without attempting to confirm the diagnosis), or pre‐emptive therapy (after screening tests for IFD).ObjectiveThis systematic review was undertaken to compare these approaches in children.MethodsWe searched PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL, Clinical Trial Registries and grey literature, for randomized controlled trials (RCT) comparing empirical versus pre‐emptive antifungal therapy in children with FN suspected to have IFD. We used the Cochrane Risk of bias 2 tool for quality assessment, and evaluated the certainty of evidence using the GRADE approach.ResultsWe identified 7989 citations. Stepwise screening identified only one relevant RCT that administered empirical (n = 73) or pre‐emptive (n = 76) antifungal therapy. There were no significant differences in all‐cause mortality (RR 1.56, 95% CI: 0.46, 5.31), IFD mortality (RR 1.04, 95% CI:0.15, 7.20) and other clinically important outcomes such as duration of fever, duration of hospitalization and proportion requiring ICU admission. There were no safety data reported. The number of days of antifungal therapy was significantly lower in the pre‐emptive therapy arm. The certainty of evidence for all outcomes was ‘moderate’.ConclusionsThis systematic review highlighted the paucity of data, comparing empirical versus pre‐emptive antifungal therapy in children with febrile neutropenia having suspected invasive fungal disease. Data from a single included trial suggests that both approaches may be comparable in research settings. Robust trials are warranted to address the gap in existing knowledge about the optimal approach in clinical practice.

中文翻译：

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对发热性中性粒细胞减少症儿童经验性抗真菌治疗与先发制人抗真菌治疗的有效性和安全性的系统评价显示数据缺乏

背景有两种方法用于治疗发热性中性粒细胞减少症患者的侵袭性真菌病（IFD），即：经验性治疗（不试图确认诊断），或先发制人的治疗（IFD 筛查测试后）。目的本系统综述旨在比较儿童中的这些方法。方法我们检索了 PubMed、EMBASE、Cochrane Library、Scopus、Web of Science 、CINAHL、临床试验注册中心和灰色文献，比较疑似 IFD 的 FN 儿童的经验性抗真菌治疗与先发性抗真菌治疗的随机对照试验 (RCT)。我们使用 Cochrane 偏倚风险 2 工具进行质量评估，并使用 GRADE 方法评估证据的确定性。结果我们确定了 7989 次引用。逐步筛选仅确定了一项进行经验性（n= 73) 或先发制人 (n=76）抗真菌治疗。全因死亡率（RR 1.56，95% CI：0.46，5.31）、IFD 死亡率（RR 1.04，95% CI：0.15，7.20）和其他临床重要结局（例如发烧持续时间、发热持续时间）没有显着差异。住院率和需要入住 ICU 的比例。没有安全数据报告。抢先治疗组的抗真菌治疗天数明显较低。所有结果的证据质量均为“中等”。 结论 这项系统评价强调了数据的缺乏，比较了疑似侵袭性真菌病的发热性中性粒细胞减少症儿童的经验性抗真菌治疗与先发性抗真菌治疗。一项纳入试验的数据表明，这两种方法在研究环境中可能具有可比性。需要进行稳健的试验来解决临床实践中最佳方法的现有知识差距。