title: Infectious events prior to chemotherapy initiation in children with acute myeloid leukemia.
abstract: BACKGROUND
  The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia.
  
  
  METHODS
  We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy.
  
  
  RESULTS
  Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation.
  
  
  CONCLUSIONS
  It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.
authors: Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors: Carol
authors: C
authors: Portwine
authors: David
authors: D
authors: Mitchell
authors: Donna
authors: D
authors: Johnston
authors: Biljana
authors: B
authors: Gillmeister
authors: Marie-Chantal
authors: MC
authors: Ethier
authors: Rochelle
authors: R
authors: Yanofsky
authors: David
authors: D
authors: Dix
authors: Sonia
authors: S
authors: Cellot
authors: Victor
authors: V
authors: Lewis
authors: Victoria
authors: V
authors: Price
authors: Mariana
authors: M
authors: Silva
authors: Shayna
authors: S
authors: Zelcer
authors: Lynette
authors: L
authors: Bowes
authors: Bruno
authors: B
authors: Michon
authors: Kent
authors: K
authors: Stobart
authors: Josee
authors: J
authors: Brossard
authors: Joseph
authors: J
authors: Beyene
authors: Lillian
authors: L
authors: Sung
mesh_terms: D000293:Adolescent; D002648:Child; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D009503:Neutropenia / Q000150:complications
references: J Pak Med Assoc. 2012 Feb;62(2):125-8
references: 22755372
references: J Clin Oncol. 2012 Dec 10;30(35):4427-38
references: 22987086
references: Neoplasma. 2012;59(6):669-75
references: 22862167
references: J Clin Oncol. 2001 Jul 15;19(14):3415-21
references: 11454890
references: Br J Haematol. 1997 Dec;99(3):580-8
references: 9401070
references: Clin Infect Dis. 2012 Dec;55(12):1608-14
references: 22955431
references: Blood. 2007 Nov 15;110(10):3532-9
references: 17660380
references: Infect Control Hosp Epidemiol. 2011 May;32(5):490-6
references: 21515980
references: Paediatr Child Health. 2007 Jan;12(1):19-21
references: 19030334
references: Pediatr Crit Care Med. 2005 Jan;6(1):2-8
references: 15636651
references: Pediatrics. 2002 Jan;109(1):45-60
references: 11773541
references: Clin Infect Dis. 2002 Mar 15;34(6):730-51
references: 11850858
references: Cancer. 2010 Feb 15;116(4):967-73
references: 20052728
references: JAMA. 2005 Jan 12;293(2):203-11
references: 15644547
references: Clin Infect Dis. 2011 Feb 15;52(4):e56-93
references: 21258094