title: Clinical and microbiologic outcomes of quinolone prophylaxis in children with acute myeloid leukemia.
abstract: BACKGROUND
  Intensifying treatment for pediatric acute myeloid leukemia (AML) has improved survival, with infections now being a leading cause of morbidity. Because quinolone prophylaxis is effective in adults with AML and in transplant populations, ciprofloxacin prophylaxis (CPx) was introduced as the standard for pediatric AML. We report here the impact of CPx in this population.
  
  
  METHODS
  Prevalence of fever and neutropenia, frequency and pathogen spectrum of infections, antibiotic use, supportive care and mortality before and after implementation of CPx were retrospectively compared in children with AML.
  
  
  RESULTS
  The cohort included 35 patients with de novo and 10 with relapsed AML, who together underwent 153 chemotherapy courses. Fever and neutropenia resulting in the use of empiric antibiotics occurred in 90% of chemotherapy courses (137/153); this was associated with proven bacteremia in 26%. The use of CPx did not change the incidence of febrile or infectious episodes, number of days of fever or antibiotic treatment or mortality. CPx was associated with a significant decrease in infections caused by Gram-negative rods (13.4% vs 4.7%) but a concomitant significant increase in bacteremia caused by viridans streptococci (12% vs 28%), resulting in no significant overall difference in the incidence of bacteremia between the 2 groups (35.9% vs 31.5%).
  
  
  CONCLUSIONS
  CPx neither alter the incidence of overall bacteremia nor change the pattern of fever or use of supportive care. Our experience supports further investigation into the use of extended-spectrum quinolone prophylaxis during therapy for pediatric AML.
authors.affiliation: From the *Division of Infectious Diseases, Children's Hospital Los Angeles, University of Southern California; †Children's Center for Cancer and Blood Diseases, University of Southern California; and ‡Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Susanna
authors.initials: S
authors.lastname: Felsenstein
authors.forename: Etan
authors.initials: E
authors.lastname: Orgel
authors.forename: Teresa
authors.initials: T
authors.lastname: Rushing
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fu
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin