Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia. Issue 13 (26th March 2014)

• Record Type: Journal Article
• Authors: Inaba, Hiroto; Gaur, Aditya H.; Cao, Xueyuan; Flynn, Patricia M.; Pounds, Stanley B.; Avutu, Viswatej; Marszal, Lindsay N.; Howard, Scott C.; Pui, Ching‐Hon; Ribeiro, Raul C.; Hayden, Randall T.; Rubnitz, Jeffrey E.
• Is Part Of: Cancer. Volume 120:Issue 13(2014)
• Page Start: 1985
• Page End: 1992
• Publication Date: 2014-03-26
• Subjects: acute myeloid leukemia -- antibiotics -- children -- infection -- prophylaxis; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28688
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Intensive chemotherapy for pediatric acute myeloid leukemia incurs the risk of infectious complications, but the benefits of antibiotic prophylaxis remain unclear. METHODS: In the current study, among 103 children treated on the AML02 protocol between October 2002 and October 2008 at St. Jude Children's Research Hospital, the authors retrospectively assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia, clinically or microbiologically confirmed infections (including bacteremia), and antibiotic resistance, as well as on the results of nasal and rectal surveillance cultures. Initially, patients received no prophylaxis or oral cephalosporin (group A). The protocol was then amended to administer intravenous cefepime alone or intravenous vancomycin plus either oral cephalosporin, oral ciprofloxacin, or intravenous cefepime (group B). RESULTS: There were 334 infectious episodes. Patients in group A had a significantly greater frequency of documented infections and bacteremia (both P < .0001) (including gram‐positive and gram‐negative bacteremia; P = .0003 and .001, respectively) compared with patients in group B, especially viridans streptococcal bacteremia ( P = .001). The incidence of febrile neutropenia without documented infection was not found to be different between the 2 groups. Five cases of bacteremia with vancomycin‐resistant enterococci (VRE) occurred in group B (vs none in group A), without related mortality. Two of these cases were preceded by positive VRE rectal surveillance cultures. CONCLUSIONS: Outpatient intravenous antibiotic prophylaxis is feasible in children with acute myeloid leukemia and reduces the frequency of documented infection but not of febrile neutropenia. Despite the emergence of VRE bacteremia, the benefits favor antibiotic prophylaxis. Creative approaches to shorten the duration of prophylaxis and thereby minimize resistance should be explored. Cancer 2014;120:1985–1992 . © 2014 American Cancer Society . Abstract : Outpatient intravenous antibiotic prophylaxis reduces the incidence of clinically or microbiologically documented infection and bacteremia, especially viridans streptococcal bacteremia, in children receiving treatment for acute myeloid leukemia. However, vancomycin‐resistant enterococcal bacteremia has been documented in patients receiving antibiotic prophylaxis, and approaches to minimize resistance should be explored.