Little is known about the epidemiology of perianal infection in pediatric cancer patients. Objectives were to describe the characteristics, treatment and outcome of perianal infection and describe features of those with and without definite abscess in pediatric patients with acute myeloid leukemia (AML).
We performed a retrospective analysis of two multi-center cohort studies investigating risk factors for infection in children with AML. We included children with de novo AML ≤ 18 years of age with a perianal infections prior to the completion of AML treatment or stem cell transplantation
Of 235 patients with AML, 17 (7%) experienced 19 perianal infections. Median age at perianal infection was 8.2 (range 0.6-16.1) years. Local bacterial cultures were positive in 6 (32%) episodes, but none matched bacteremia isolates (n=5). Enterobacteriacae were the most common pathogen.
The 19 episodes were stratified by definite abscess (n=12) and cellulitis/phlegmon (n=7). All patients presented with local pain, erythema and induration or swelling. Fever was a frequent finding (n=17, 89.4%). Among the patients with abscess, 9 (75%) were severely neutropenic at diagnosis and surgical intervention was required in 8 (42%). All patients received antibiotics; Metronidazole (n=14) and Piperacillin/Tazobactam (n=10) were the drugs most frequently used for treatment.
Imaging was commonly performed (n=16). Diagnostic yield was similar between computerized tomography of pelvis (5/10) and ultrasound (3/5). Severe complications occurred including fistula (n=1), skin necrosis (n=2) and mortality (n=1).
Perianal infections occurred in 7% of pediatric patients with AML, with many consisting of definite abscess. Diagnostic yield were similar regardless of imaging modality and therefore, ultrasound may be considered for initial evaluation. Future research should develop consistent management approaches to perianal infection in order to improve outcomes.
S. Ali, None
C. Portwine, None
D. Mitchell, None
D. Dix, None
V. Lewis, None
V. Price, None
D. Johnston, None
L. Sung, None