title: High Infection-Related Mortality in Pediatric Acute Myeloid Leukemia without Preventive Antibiotics and Antifungals: Retrospective Cohort Study of a Single Center from a Middle-Income Country.
abstract: OBJECTIVE
  This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country.
  
  
  METHODS
  Infection-related mortality was evaluated retrospectively in 49 pediatric patients.
  
  
  RESULTS
  A total of 173 chemotherapy courses were administered as first-line chemotherapy. Four patients died during induction: one patient due to intracranial bleeding, two patients due to typhlitis, and one patient due to invasive fungal infection with pulmonary vascular invasion and massive bleeding. Another two patients died with resistant disease. During consolidation there were four infection-related deaths and one death due to cardiotoxicity. In first-line chemotherapy mortality was 22% (11/49); infection-related mortality was 14% (7/49). Event-free survival and overall survival at 6 years were 42.9% and 61.2% (95% CI: 44-76 and 66-99 months), respectively.
  
  
  CONCLUSIONS
  Due to considerable infection-related deaths, antibacterial and mold-active antifungal prophylaxis may be tried during neutropenic periods in pediatric AML.
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Zengin
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Nazan
authors.initials: N
authors.lastname: Sarper
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Aylan Gelen
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Demirsoy
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Meriban
authors.initials: M
authors.lastname: Karadoğan
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
authors.forename: Suar
authors.initials: S
authors.lastname: Çakı Kılıç
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Öncel
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey.
authors.forename: Emin Sami
authors.initials: ES
authors.lastname: Arısoy
authors.affiliation: Kocaeli University Faculty of Medicine, Department of Microbiology, Kocaeli, Turkey.
authors.forename: Devrim
authors.initials: D
authors.lastname: Dündar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D000072742:Invasive Fungal Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Acute myeloid leukemia; Febrile neutropenia Infection.; Pediatric leukemia