Importance of neutropenia for development of invasive infections at various phases of treatment for hemato-oncological diseases in children.
BACKGROUND
Prolonged neutropenia in patients with acute myeloid leukemia (AML), relapsed acute lymphoblastic leukemia (r-ALL), myelodysplastic syndrome (MDS), and those receiving hematopoietic stem cell transplantation (HSCT), is a well-known risk factor for infectious complications. Few data are available about the incidence and etiology of infectious episodes during the total treatment period associated with a decreased immunity.


METHODS
Between January 2000 and December 2005 children diagnosed with AML, r-ALL, and MDS, and post-HSCT patients were included in the study. A retrospective review based on microbiological data was performed to describe the incidence and etiology of the infectious complications during the total treatment period.


RESULTS
One hundred and thirty disease-specific patient episodes were included. Forty-two percent of 184 microbiologically proven infectious episodes were diagnosed in patients receiving chemotherapy, and 58% occurred in HSCT patients. During neutropenia, 123 (67%) infectious episodes were diagnosed; of the isolated species 83% were bacterial, 6% fungal, and 11% viral. In the period without neutropenia, 61 (33%) infectious episodes were diagnosed, with 38% bacterial, 3% fungal, and 59% viral species isolated. Of the infectious episodes diagnosed in patients treated with an HSCT, 52% (n = 55) occurred in the post-engraftment period. In contrast, in patients treated with chemotherapy, 92% of the infectious episodes were diagnosed during neutropenia.


CONCLUSIONS
The number of proven infectious episodes in post-HSCT patients was not influenced by the presence of neutropenia, while in patients receiving chemotherapy significantly lower numbers of proven infectious episodes were diagnosed outside the neutropenic period.
Department of Pediatric Hematology and Oncology, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands. a.zwitserloot@cukz.umcn.nl
Annelies M
AM
Zwitserloot
Annelies M C
AM
Mavinkurve-Groothuis
Joep M
JM
Galama
Paul E
PE
Verweij
Peter M
PM
Hoogerbrugge
Adilia
A
Warris
D000293:Adolescent; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D007239:Infections / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D007938:Leukemia; D008297:Male; D009181:Mycoses / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D009503:Neutropenia / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D014777:Virus Diseases / Q000150:complications / Q000453:epidemiology / Q000821:virology