Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

Hiroto Inaba, Aditya H. Gaur, Xueyuan Cao, Patricia M. Flynn, Stanley B. Pounds, Viswatej Avutu, Lindsay N. Marszal, Scott Howard, Ching Hon Pui, Raul C. Ribeiro, Randall T. Hayden, Jeffrey E. Rubnitz

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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.

Original languageEnglish (US)
Pages (from-to)1985-1992
Number of pages8
JournalCancer
Volume120
Issue number13
DOIs
StatePublished - Jul 1 2014

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Bacteremia
Acute Myeloid Leukemia
Outpatients
Antibiotic Prophylaxis
Febrile Neutropenia
Cephalosporins
Infection
Vancomycin
Ciprofloxacin
Microbial Drug Resistance
Nose
Pediatrics
Drug Therapy
Mortality
Incidence
Research
Vancomycin-Resistant Enterococci
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Inaba, H., Gaur, A. H., Cao, X., Flynn, P. M., Pounds, S. B., Avutu, V., ... Rubnitz, J. E. (2014). Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia. Cancer, 120(13), 1985-1992. https://doi.org/10.1002/cncr.28688

Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia. / Inaba, Hiroto; Gaur, Aditya H.; Cao, Xueyuan; Flynn, Patricia M.; Pounds, Stanley B.; Avutu, Viswatej; Marszal, Lindsay N.; Howard, Scott; Pui, Ching Hon; Ribeiro, Raul C.; Hayden, Randall T.; Rubnitz, Jeffrey E.

In: Cancer, Vol. 120, No. 13, 01.07.2014, p. 1985-1992.

Research output: Contribution to journalArticle

Inaba, H, Gaur, AH, Cao, X, Flynn, PM, Pounds, SB, Avutu, V, Marszal, LN, Howard, S, Pui, CH, Ribeiro, RC, Hayden, RT & Rubnitz, JE 2014, 'Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia', Cancer, vol. 120, no. 13, pp. 1985-1992. https://doi.org/10.1002/cncr.28688
Inaba, Hiroto ; Gaur, Aditya H. ; Cao, Xueyuan ; Flynn, Patricia M. ; Pounds, Stanley B. ; Avutu, Viswatej ; Marszal, Lindsay N. ; Howard, Scott ; Pui, Ching Hon ; Ribeiro, Raul C. ; Hayden, Randall T. ; Rubnitz, Jeffrey E. / Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia. In: Cancer. 2014 ; Vol. 120, No. 13. pp. 1985-1992.
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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.",
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AU - Inaba, Hiroto

AU - Gaur, Aditya H.

AU - Cao, Xueyuan

AU - Flynn, Patricia M.

AU - Pounds, Stanley B.

AU - Avutu, Viswatej

AU - Marszal, Lindsay N.

AU - Howard, Scott

AU - Pui, Ching Hon

AU - Ribeiro, Raul C.

AU - Hayden, Randall T.

AU - Rubnitz, Jeffrey E.

PY - 2014/7/1

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N2 - 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.

AB - 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.

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