title: Second Bacteremia During Antibiotic Treatment in Children With Acute Myeloid Leukemia: A Report From the Canadian Infections in Acute Myeloid Leukemia Research Group.
abstract: BACKGROUND
  The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Our objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML).
  
  
  METHODS
  We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death.
  
  
  RESULTS
  There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12; P < .0001), cumulative dose of corticosteroids (OR, 1.04; 95% CI, 1.00-1.08; P = .035), and days of neutropenia from start of course to initial bacteremia (OR, 1.07; 95% CI, 1.02-1.12; P = .007) were significantly associated with second bacteremia.
  
  
  CONCLUSIONS
  In pediatric AML, 6% of patients will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia.
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Thai Hoa
authors.initials: TH
authors.lastname: Tran
authors.affiliation: Hematology/Oncology, CancerCare Manitoba, Winnipeg, Canada.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Yanofsky
authors.affiliation: Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Johnston
authors.affiliation: Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Dix
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Biljana
authors.initials: B
authors.lastname: Gillmeister
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.affiliation: Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Portwine
authors.affiliation: Pediatrics, IWK Health Centre, Halifax, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Price
authors.affiliation: Hematology/Oncology, Montreal Children's Hospital, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: Hematology/Oncology, Hopital Sainte-Justine, Montreal, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cellot
authors.affiliation: Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Lewis
authors.affiliation: Hematology/Oncology, London Health Sciences Centre, Canada.
authors.forename: Shayna
authors.initials: S
authors.lastname: Zelcer
authors.affiliation: Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Canada.
authors.forename: Mariana
authors.initials: M
authors.lastname: Silva
authors.affiliation: Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Canada.
authors.forename: Bruno
authors.initials: B
authors.lastname: Michon
authors.affiliation: Hematology/Oncology, Janeway Child Health Centre, St John's, Canada.
authors.forename: Lynette
authors.initials: L
authors.lastname: Bowes
authors.affiliation: Stollery Children's Hospital, University of Alberta Edmonton, Canada.
authors.forename: Kent
authors.initials: K
authors.lastname: Stobart
authors.affiliation: Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Canada.
authors.forename: Josée
authors.initials: J
authors.lastname: Brossard
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
keywords: acute myeloid leukemia; children; infection; neutropenia; second bacteremia