Cefepime and mortality in pediatric acute myelogenous leukemia: a retrospective cohort study.
BACKGROUND
Based on 2 meta-analyses, the Food and Drug Administration issued a communication in 2009 regarding the potential risk of death in patients treated with cefepime. Pediatric patients with acute myelogenous leukemia (AML) have frequent episodes of fever necessitating the use of antibiotics such as cefepime. We evaluated the association of cefepime and other beta-lactam antibiotic exposures with all cause in-hospital mortality in pediatric AML patients.


METHODS
We performed a retrospective cohort study using the Pediatric Health Information System, an inpatient database. Exposure to cefepime, ceftazidime, antipseudomonal penicillin, and carbapenems was evaluated for each 30-day period within the first year from AML diagnosis. Cox regression analysis was used to compute hazard ratios (HR) for death adjusting for demographics, clinical variables, and clustering by hospital. The final analysis used 2 distinct time periods (0-3 months and >3-12 months) to account for variation in proportional hazards over time.


RESULTS
No differences between the HRs for mortality were observed for the time period of 0 to 3 months (cefepime vs. ceftazadime: HR=1.33, 95% CI: 0.70-2.52; cefepime vs. antipseudmonal penicillin: HR=0.86, 95% CI: 0.34-2.13; and cefepime vs. carbapenems: HR=1.08, 95% CI: 0.50-2.35) or the time period of >3 to 12 months after diagnosis (cefepime vs. ceftazadime: HR=1.29, 95% CI: 0.53-3.15; cefepime vs. antipseudomonal penicillin: HR=1.08, 95% CI: 0.44-2.66; and cefepime vs. carbapenems: HR=1.03, 95% CI: 0.45-2.33).


CONCLUSIONS
In this cohort of pediatric AML patients, cefepime exposure in the 30 days preceding death did not result in an increased mortality risk when compared with ceftazidime, antipseudomonal penicillins, or carbapenems.
Division of Infectious Diseases, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. fisherbria@email.chop.edu
Brian T
BT
Fisher
Richard
R
Aplenc
Russell
R
Localio
Kateri H
KH
Leckerman
Theoklis E
TE
Zaoutis
D000293:Adolescent; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime