1552. Bacteremia during the Induction Phase of Treatment for Acute Lymphoblastic Leukemia Treatment in Children: Interest of an Antibiotic Prophylaxis ?
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Katell poster.pdf (423.6 kB)
  • Background:

    Infections are a major complication of the induction phase of treatment for acute lymphoblastic leukemia (ALL). We aimed to describe characteristics of children with bacteremia during this period of chemotherapy.

    Methods:

    Medical charts of children treated for ALL who completed the BOSTON-2005-protocol induction phase were retrospectively analyzed, between 2006 and 2012. Clinical and microbiological characteristics were collected. Bacteremia was defined by a positive blood culture, from day of admission to day 32 after the onset of chemotherapy, regardless of the nature of the pathogen. Only the first episode of bacteremia was considered.

    Results:

    171 patients with a median age of 4.7 years (1-17.3) were included. Neutropenia was present at admission in 98 cases (57%), and lasted a mean of 25.8 days (SD 11.2). A wide spectrum antibiotic was administered at any time of the induction phase in 142/171 (83%) of patients for febrile neutropenia (FN); and was started at day of admission in 116/171 cases (68%). Bacteremia occurred in 29/171 children, with an overall incidence of 16.2 % (SD 8.2) that ranged from 5.3 % in 2006 to 29.6% in 2011. The mean time of onset of bacteremia was 13.1 days (SD 8.3) from the day of diagnosis. Bacteriemia was more frequently observed in patients who were not receiving antibiotics (14/29, 48.6%, p<0.02). The time of onset was significantly different in the 15/29 children (17 days, SD 6.0) already on antibiotics for FN, compared with the 14 children who were not on antibiotics (8.3 days, SD 8.7, p=0.004). Moraxella sp and Staphyloccus aureus were the most common pathogens isolated in children who were not receiving antibiotics (42.9%, 6/14), whereas Streptococcus sp and coagulase negative Staphylococci represented 60% (9/15) of the pathogens isolated in patients already on antibiotics for FN (p<0.002). No significant clinical (age, type of ALL) or biological (neutropenia at diagnosis, duration of neutropenia) predisposing factor for bacteremia was identified.

    Conclusion:

    Bacteremia during the induction phase of ALL chemotherapy is a frequent event, despite the use of wide-spectrum antibiotics. It occurs early in half of patients who are not receiving antibiotics. The risk benefit of prophylactic antibiotics should be assessed in these patients, given the potential for inducing drug resistance.


    Katell Michaux, MD1, Clement Legeay, PharmD2, Diane Larocque, PharmD2, Jean-Marie Leclerc, MD3, Caroline Laverdiere, MD3, Celine Laferriere, MD4, Bruce Tapiero, MD1 and Philippe Ovetchkine, MD MSc1, (1)Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine University of Montreal, Montreal, QC, Canada, (2)Department of Pharmacy, CHU Sainte-Justine University of Montreal, Montreal, QC, Canada, (3)Department of Pediatrics, Division of Onco-Hematology, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada, (4)Department of Microbiology and Immunology, Hopital Sainte Justine, Montreal, QC, Canada

    Disclosures:

    K. Michaux, None

    C. Legeay, None

    D. Larocque, None

    J. M. Leclerc, None

    C. Laverdiere, None

    C. Laferriere, None

    B. Tapiero, None

    P. Ovetchkine, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.