title: High frequency of streptococcal bacteraemia during childhood AML therapy irrespective of dose of cytarabine.
abstract: BACKGROUND
  High-dose cytarabine has been associated with a high frequency of viridans group streptococcal (VGS) bacteraemia. VGS bacteraemia causes considerable morbidity and mortality. The Nordic Society of Paediatric Haematology and Oncology (NOPHO)-AML protocols use higher cumulated doses of cytarabine and more chemotherapy series (n = 6) than other protocols with the potential increased risk of severe VGS infections.
  
  
  METHODS
  Medical records of all Danish children enrolled on the NOPHO-AML-2004 protocol between January 2004 and September 2011 (n = 45) were retrospectively reviewed and all febrile episodes were registered.
  
  
  RESULTS
  Following 236 courses of chemotherapy, 112 positive blood cultures were registered. VGS were found in 38% of all positive blood cultures. Infectious episodes with VGS resulted in more days of fever and intravenous antibiotic therapy compared with infections caused by other microorganisms. VGS were involved in 45% of all episodes categorized as sepsis (n = 51) and in 67% of life-threatening bloodstream infections (n = 9). Penicillin resistance was found in 40% of the VGS strains. No significant difference was observed in the proportion of VGS isolated following courses with low-dose cytarabine versus courses with high-dose cytarabine.
  
  
  CONCLUSIONS
  VGS were the most commonly isolated pathogens causing the most severe infections and the majority of life-threatening infections. A substantial proportion of the strains were resistant to penicillin. The high rate of VGS seemed independent of high-dose cytarabine but was more likely caused by the intensive chemotherapy treatment leading to severe mucositis and neutropenia.
authors.affiliation: Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Katrine Helle
authors.initials: KH
authors.lastname: Johannsen
authors.forename: Mette Møller
authors.initials: MM
authors.lastname: Handrup
authors.forename: Birgitte
authors.initials: B
authors.lastname: Lausen
authors.forename: Henrik
authors.initials: H
authors.lastname: Schrøder
authors.forename: Henrik
authors.initials: H
authors.lastname: Hasle
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy*; D008297:Male; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D034363:Viridans Streptococci
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine