title: Antibiotic use during infectious episodes in the first 6 months of anticancer treatment-A Swedish cohort study of children aged 7-16 years.
abstract: BACKGROUND
  Children undergoing cancer therapy are at risk for infectious complications that require hospitalization and antimicrobial therapy. Host factors such as age and underlying disease may predict the risk of severe infections in these children. To describe the increased morbidity due to infections in children with cancer, we characterized the antibiotic use during the infectious complications in a national cohort of children 7-16 years of age with cancer.
  
  
  METHODS
  Data on infectious complications were prospectively collected from the medical records of all newly diagnosed children with cancer, aged 7-16 years, in Sweden between 2004 and 2006. An episode of infection was defined as a period of time when oral or intravenous antimicrobial treatment was prescribed because of symptoms of infection.
  
  
  RESULTS
  A total of 230 infectious episodes occurred in 80 of the 101 patients. Pathogens were isolated in 15% of the blood cultures that showed a predominance of Gram-positive bacteria. Intravenous broad-spectrum antibiotics with cephalosporins and carbapenems were mostly used as single drugs but also in combination with aminoglycosides and glycopeptide. The median treatment length varied between 6 and 11 days depending on cancer diagnosis.
  
  
  CONCLUSIONS
  Our data demonstrate that infectious complications contribute significantly to morbidity in children with cancer aged 7-16 years. At the time of this survey, antibiotic prescription patterns varied and cephalosporins and carbapenems were mostly used. With increasing antibiotic resistance, a more stringent antibiotic stewardship with less use of cephalosporins and carbapenems should be encouraged for children with cancer. Data on prescription patterns should be incorporated as a quality measurement in pediatric cancer care.
authors.affiliation: Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.|Department of Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Af Sandeberg
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Johansson
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Wettergren
authors.affiliation: Department of Women's and Children's Health, Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Björk
authors.affiliation: Pediatric Infectious Disease Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Hertting
authors.affiliation: Department of Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D009369:Neoplasms / Q000150:complications*; D010818:Practice Patterns, Physicians'; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial therapy; cancer; children; infections; neutr