title: Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia.
abstract: BACKGROUND
  Intensive chemotherapy for pediatric acute myeloid leukemia incurs the risk of infectious complications, but the benefits of antibiotic prophylaxis remain unclear.
  
  
  METHODS
  In the current study, among 103 children treated on the AML02 protocol between October 2002 and October 2008 at St. Jude Children's Research Hospital, the authors retrospectively assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia, clinically or microbiologically confirmed infections (including bacteremia), and antibiotic resistance, as well as on the results of nasal and rectal surveillance cultures. Initially, patients received no prophylaxis or oral cephalosporin (group A). The protocol was then amended to administer intravenous cefepime alone or intravenous vancomycin plus either oral cephalosporin, oral ciprofloxacin, or intravenous cefepime (group B).
  
  
  RESULTS
  There were 334 infectious episodes. Patients in group A had a significantly greater frequency of documented infections and bacteremia (both P < .0001) (including gram-positive and gram-negative bacteremia; P = .0003 and .001, respectively) compared with patients in group B, especially viridans streptococcal bacteremia (P = .001). The incidence of febrile neutropenia without documented infection was not found to be different between the 2 groups. Five cases of bacteremia with vancomycin-resistant enterococci (VRE) occurred in group B (vs none in group A), without related mortality. Two of these cases were preceded by positive VRE rectal surveillance cultures.
  
  
  CONCLUSIONS
  Outpatient intravenous antibiotic prophylaxis is feasible in children with acute myeloid leukemia and reduces the frequency of documented infection but not of febrile neutropenia. Despite the emergence of VRE bacteremia, the benefits favor antibiotic prophylaxis. Creative approaches to shorten the duration of prophylaxis and thereby minimize resistance should be explored.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inaba
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Cao
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Pounds
authors.forename: Viswatej
authors.initials: V
authors.lastname: Avutu
authors.forename: Lindsay N
authors.initials: LN
authors.lastname: Marszal
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D002177:Candidiasis / Q000175:diagnosis; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage; D060830:Consolidation Chemotherapy / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D060828:Induction Chemotherapy / Q000009:adverse effects; D007223:Infant; D007262:Infusions, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D009666:Nose / Q000382:microbiology; D010045:Outpatients / Q000706:statistics & numerical data; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D014640:Vancomycin; D000077723:Cefepime
keywords: acute myeloid leukemia; antibiotics; children; infection; prophylaxis