1279. Predictors and Outcomes of Viridans Group Streptococcal Infections in Pediatric Acute Myeloid Leukemia: From the Canadian Infections in AML Research Group
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • AML VGS_IDWeek2013_Ethier.pdf (132.0 kB)
  • Background: Viridans group streptococci (VGS) cause significant morbidity in children treated for acute myeloid leukemia (AML). Our goals were to determine the occurrence and impact of these infections in children treated for AML and to identify risk factors of VGS infections and viridans streptococcal shock syndrome (VSSS) in this population.

    Methods: We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo AML treated at 15 Canadian centers between January 1, 1995 and December 31, 2004. Children with Down syndrome were included. The analysis was limited to those with VGS isolated from a normally sterile site. We evaluated factors related to VGS infection and VSSS. Repeated logistic regression analysis using generalized estimating equations was used to construct the prediction models for VGS infections and VSSS.

    Results: Among 341 children with AML, VGS occurred in 78 (22.9%) children over the entire course of therapy. Of those with VGS, 16 (20.5%) had recurrent episodes. VGS infection occurred in 97 of 1277 courses of chemotherapy (7.6%).  VSSS occurred in 19.6% of these episodes and included 11 patients who required admission to the intensive care unit. Two VGS infections resulted in death. In multiple regression analysis, factors independently related to VGS included treatment on a United Kingdom Medical Research Council-based protocol (odds ratio (OR) 2.87, 95% confidence interval (CI) 1.53 to 5.39; P=0.001), cytarabine dose per gram/m2 (OR 1.04, 95% CI 1.01 to 1.07; P=0.002), and prolonged neutropenia (OR 1.58, 95% CI 0.97 to 2.56; P=0.06).  Era, age, Down Syndrome, obesity, treatment on a Children’s Cancer Group protocol, registration on study protocol and number of days receiving corticosteroids were not predictive of VGS infection. None of the evaluated factors were predictive of VSSS.

    Conclusion: VGS infections occur in 7.6% of chemotherapy courses. They remain an important cause of morbidity and mortality in children receiving treatment for AML. Interventions to reduce VGS and VGGS such as prophylaxis need to be identified, especially for those identified as having factors that may help identify them as being high risk.

    Marie-Chantal Ethier, BSc1, Victor Lewis, MD2, Rochelle Yanofsky, MD3, David Mitchell, MD4, David Dix, MD5, Biljana Gillmeister, MSc1, Donna Johnston, MD6, Bruno Michon, MD7, Kent Stobart, MD8, Carol Portwine, PhD9, Mariana Silva, MD10, Sonia Cellot, MD11, Victoria Price, MMed12, Lynette Bowes, MD13, Shayna Zelcer, MD14, Josee Brossard, MD15, Joseph Beyene, PhD16 and Lillian Sung, MD PhD1, (1)The Hospital for Sick Children, Toronto, ON, Canada, (2)Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada, (3)CancerCare Manitoba, Winnipeg, MB, Canada, (4)Montreal Children's Hospital, Montreal, QC, Canada, (5)British Columbia Children's Hospital, Vancouver, BC, Canada, (6)Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (7)Centre Hospitalier Universitaire de Quebec, Quebec, QC, Canada, (8)Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada, (9)McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, ON, Canada, (10)Cancer Centre of Southeastern Ontario, Kingston, ON, Canada, (11)Hospital Sainte-Justine, Montreal, QC, Canada, (12)IWK Health Centre, Halifax, NS, Canada, (13)Janeway Child Health Centre, St.John's, NF, Canada, (14)London Health Sciences, London, ON, Canada, (15)Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada, (16)McMaster University, Hamilton, ON, Canada


    M. C. Ethier, None

    V. Lewis, None

    R. Yanofsky, None

    D. Mitchell, None

    D. Dix, None

    B. Gillmeister, None

    D. Johnston, None

    B. Michon, None

    K. Stobart, None

    C. Portwine, None

    M. Silva, None

    S. Cellot, None

    V. Price, None

    L. Bowes, None

    S. Zelcer, None

    J. Brossard, None

    J. Beyene, None

    L. Sung, 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.