title: Infections Caused by Rapidly Growing Mycobacteria spp in Children and Adolescents With Cancer.
abstract: BACKGROUND
  Rapidly growing mycobacteria (RGM) infections in pediatric oncology patients have not been completely characterized.
  
  
  METHODS
  We reviewed medical records of oncology patients at St. Jude Children's Research Hospital (St. Jude) from 1990 to 2010 with RGM infections and summarized the results of previously published cases.
  
  
  RESULTS
  Twenty-five St. Jude patients had 27 episodes of infection. Approximately half of the cases occurred in patients with hematological malignancies and in males; infections were more common in white patients. Most patients were not neutropenic or lymphopenic. The most common causative species were Mycobacterium chelonae, Mycobacterium abscessus, and Mycobacterium fortuitum. Most isolates were susceptible to amikacin and clarithromycin; all were susceptible to at least 1 of these. Treatment regimens varied considerably, particularly with respect to the duration of antimicrobial chemotherapy. Two St. Jude patients died; both had pulmonary infections. The literature search identified an additional 58 cases of infection. Localized catheter-associated infections were more common than bloodstream infections in the current series than in previous reports, and outbreaks were not recognized. Otherwise, the demographic and clinical characteristics of patients were similar.
  
  
  CONCLUSIONS
  Localized catheter-associated infections were most common in this largest reported single center experience reported to date. Pulmonary infection is uncommon in children but, as in adults, has a high mortality rate. Relatively short-term antimicrobial treatment and surgical debridement of infected tissue, if present, may be as effective for catheter-associated infections as prolonged antimicrobial use and may reduce adverse drug effects in these patients, who are vulnerable to drug-drug interactions and toxicity.
authors.affiliation: Departments of Infectious Diseases.
authors.forename: Nopporn
authors.initials: N
authors.lastname: Apiwattankul
authors.affiliation: Departments of Infectious Diseases Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.affiliation: Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.affiliation: Departments of Infectious Diseases Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis.
authors.forename: Elisabeth E
authors.initials: EE
authors.lastname: Adderson
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000145:classification / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D003646:Debridement / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects*; D007223:Infant; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D009161:Mycobacterium / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D009164:Mycobacterium Infections / Q000145:classification* / Q000188:drug therapy* / Q000601:surgery*; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents; D000583:Amikacin; D017291:Clarithromycin
keywords: cancer; infection; mycobacteria; pediatric