1551. Antibiotic prophylaxis during chemotherapy in children with Acute Myeloid Leukemia
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C


Infections continue to be a leading cause of morbidity and mortality in children receiving chemotherapy for acute myeloid leukemia (AML). Adult data from oncological and bone marrow transplant populations suggests that antibiotic prophylaxis with quinolones may decrease infection related and all-cause morbidity and mortality. Outcome data for children on antibiotic prophylaxis, including quinolones, during chemotherapy is limited.


A chart review of patients with AML treated at CHLA between 2008 and 2012 was performed. Chemotherapy cycles in which quinolone prophylaxis was initiated at the time of neutropenia with those in which prophylaxis was not employed were compared. Outcome measures included infection-related morbidity and mortality, length of hospitalization, duration and type of treatment antibiotics, microbiological and resistance profile of infections. 


PICU stay, radiological exposure, number and duration of fever episodes as well as febrile days did not differ between the two groups (p=0.673; Fig. 1).  Of 198 episodes of fever, 24% were microbiologically proven bacteremias; there was no difference between chemotherapy cycles covered with ciprofloxacin (32.8%) and those that were not (30.3%; p=0.86; Fig. 2).  However, the microbiological spectrum differed remarkably (Fig. 3): gram-negative bacteremia was less frequent in those who received ciprofloxacin (4.7% versus 18% p=0.098), and bacteremias by Streptococcus mitis appeared more frequent in children on ciprofloxacin (26.6% versus 11.2% p=0.018).  3/22 gram-negative isolates were ciprofloxacin resistant, in 2/3 prior ciprofloxacin exposure had been present. Mortality did not differ, but was highly associated with invasive fungal disease.


Our data demonstrates that ciprofloxacin prophylaxis decreases gram-negative infections in these high risk patients, but that oral gram positive flora remain a leading threat for patients, perhaps related to AraC associated mucositis, will not be impacted by this intervention. Additional means of prevention are therefore required and may include meticulous oral hygiene and prophylaxis with agents active against these specific pathogens.

Susanna Felsenstein, MD, Pediatric Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, CA, Jill A. Hoffman, MD, Children's Hospital, Los Angeles, Los Angeles, CA and Etan Orgel, MD, Children's Hospital Los Angeles, Los Angeles, CA


S. Felsenstein, None

J. A. Hoffman, None

E. Orgel, None

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