The PIPPIN Study: A practice changing multi-centre RCT performed by Dr Abby Douglas, NCIC Fellow.

The NCIC led PIPPIN study has demonstrated that you can reduce length of hospital stay and antimicrobial use by using PET scans instead of CT scans in the management of ongoing neutropenic fever in bone marrow transplant patients or those with acute leukaemia.  

Neutropenia is a condition where a patient has a very low white blood cell count, making the person more susceptible to infection. Unfortunately, neutropenic patients who have ongoing fever often have very few focal symptoms which makes it challenging for the doctor to uncover where or what is causing the infection. Importantly, these patients are vulnerable to serious infections and consequences of untreated infection such as intensive care admission and mortality, hence accurately detecting the cause of fever is vitally important and challenging up until now.   

A CT scan is the standard of care to help the doctor uncover the cause of infection, but this technique is not always accurate, and we wanted to find a better diagnostic test.  The PIPPIN trial compared the use of CT scan to FDG-PET-CT scan to learn what impact the information obtained from the scan was having on antimicrobial use. We looked at whether it resulted in the use of more narrow spectrum treatments and if it resulted in stopping therapy when it was not needed. 

The results clearly showed that FDG-PET-CT scan was a better diagnostic tool as it helped to rationalise the use of antimicrobials as well as reduce hospital stay. These findings will result in improved patient outcomes, reduced costs, improved antimicrobial stewardship and are currently being translated into clinical guidelines. 

Other Febrile Neutropenia Resources

Low risk: "No place like home" is an ambulatory management program for patients at low risk of neutropenic fever. We have developed an implementation Low risk toolkit to assist health care workers in implementing this program at their own centres. Please ensure that they are appropriately adapted for your centre following multi-disciplinary stakeholder consultation.

Moderate to high risk: We have put together the Australian consensus guidelines for the management of neutropenic fever in adult cancer patients.

We have compiled a list of FAQs from consumers on Febrile Neutropenia.