Food Safety Practices and Foodborne Illness in Italian Pediatric Oncology and Hematology Centers: A Survey on Behalf of the Infectious Disease Working Group of AIEOP

Background: Food safety practices are widely recommended for pediatric patients with cancer or undergoing hematopoietic stem cell transplantation (HCT) to mitigate foodborne infectious risks. However, specific measures, such as the neutropenic diet (ND) or low-microbial diet, lack robust evidence and are inconsistently implemented across pediatric hematology-oncology centers. Additionally, data on foodborne illnesses (FBI) in this population remain scarce. Procedure: We conducted an online survey and a retrospective review of FBI cases across 22 centers within the Italian Association of Pediatric Hematology and Oncology (AIEOP) network, 13/22 performing allogeneic HCT. Results: All centers provide dietary recommendations to the patients. Restrictive diets are recommended in 72% of centers during hospitalization and in 77% after discharge. Universally avoided foods include unpasteurized milk, fresh fruit without skin, moldy cheeses, bakery and ice cream products, raw eggs and derivatives, raw meat, raw or smoked fish, cured meats, shellfish, and cooked food leftovers. Fresh fruits and vegetables are commonly restricted only to patients undergoing allogeneic HCT. Ninety-five percent of centers provide patients and their families with guidelines on cleaning food at home, including thorough cleaning of fruits and vegetables with a food disinfectant. Seven centers reported FBI cases, with eight documented cases, including two fatalities caused by meningoencephalitis related to infections from Listeria monocytogenes and Bacillus cereus, respectively. Conclusions: This study highlights the need for standardized, evidence-based food safety guidelines and FBI management to enhance care for pediatric patients receiving chemotherapy or HCT.