Effect of Antibacterial Prophylaxis on Febrile Neutropenic Episodes and Bacterial Bloodstream Infections in Dutch Pediatric Patients with Acute Myeloid Leukemia: A Two-Center Retrospective Study

Romy E. Van Weelderen*, Kim Klein, Bianca F. Goemans, Wim J. E. Tissing, Tom F. W. Wolfs, Gertjan J. L. Kaspers

*Corresponding author for this work

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Abstract

Simple Summary The intensive chemotherapy that children with acute myeloid leukemia (AML) receive puts them at high risk of infections. Bloodstream infections (BSI) caused by bacteria are common and known for their associated complications but may be prevented by the use of antibacterial agents. Literature on this matter is scarce. We evaluated the effect of different antibacterial prophylaxis regimens on the occurrence of fever and bacterial BSIs in 82 Dutch children with AML. A combination of prophylactic teicoplanin and ciprofloxacin had the best outcomes, resulting in significantly fewer episodes of fever and bacterial BSIs. The combination of teicoplanin and ciprofloxacin was previously suggested by others, but not yet studied. Currently, a randomized trial is ongoing to address and validate the efficacy of teicoplanin prophylaxis in pediatric AML. Bloodstream infections (BSIs), especially those caused by Gram-negative rods (GNR) and viridans group streptococci (VGS), are common and potentially life-threatening complications of pediatric acute myeloid leukemia (AML) treatment. Limited literature is available on prophylactic regimens. We retrospectively evaluated the effect of different antibacterial prophylaxis regimens on the incidence of febrile neutropenic (FN) episodes and bacterial BSIs. Medical records of children (0-18 years) diagnosed with de novo AML and treated at two Dutch centers from May 1998 to March 2021 were studied. Data were analyzed per chemotherapy course and consecutive neutropenic period. A total of 82 patients had 316 evaluable courses: 92 were given with single-agent ciprofloxacin, 138 with penicillin plus ciprofloxacin, and 51 with teicoplanin plus ciprofloxacin. The remaining 35 courses with various other prophylaxis regimens were not statistically compared. During courses with teicoplanin plus ciprofloxacin, significantly fewer FN episodes (43 vs. 90% and 75%; p < 0.0001) and bacterial BSIs (4 vs. 63% and 33%; p < 0.0001) occurred than with single-agent ciprofloxacin and penicillin plus ciprofloxacin, respectively. GNR and VGS BSIs did not occur with teicoplanin plus ciprofloxacin and no bacterial BSI-related pediatric intensive care unit (PICU) admissions were required, whereas, with single-agent ciprofloxacin and penicillin plus ciprofloxacin, GNR BSIs occurred in 8 and 1% (p = 0.004), VGS BSIs in 24 and 14% (p = 0.0005), and BSI-related PICU admissions were required in 8 and 2% of the courses (p = 0.029), respectively. Teicoplanin plus ciprofloxacin as antibacterial prophylaxis is associated with a lower incidence of FN episodes and bacterial BSIs. This may be a good prophylactic regimen for pediatric AML patients during treatment.

Original languageEnglish
Article number3172
Number of pages15
JournalCancers
Volume14
Issue number13
DOIs
Publication statusPublished - 28-Jun-2022

Keywords

  • pediatric acute myeloid leukemia
  • febrile neutropenia
  • bloodstream infections
  • viridans group streptococci
  • Gram-negative rods
  • antibacterial prophylaxis
  • teicoplanin
  • ciprofloxacin
  • TREATMENT-RELATED MORTALITY
  • INTENSIVE TREATMENT
  • CHILDREN
  • CHEMOTHERAPY
  • CANCER
  • ANTIBIOTICS
  • COMPLICATIONS
  • CIPROFLOXACIN
  • BACTEREMIA
  • GUIDELINE

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