TY - JOUR
T1 - Infectious Events Prior to Chemotherapy Initiation in Children with Acute Myeloid Leukemia
AU - Portwine, Carol
AU - Mitchell, David
AU - Johnston, Donna
AU - Gillmeister, Biljana
AU - Ethier, Marie Chantal
AU - Yanofsky, Rochelle
AU - Dix, David
AU - Cellot, Sonia
AU - Lewis, Victor
AU - Price, Victoria
AU - Silva, Mariana
AU - Zelcer, Shayna
AU - Bowes, Lynette
AU - Michon, Bruno
AU - Stobart, Kent
AU - Brossard, Josee
AU - Beyene, Joseph
AU - Sung, Lillian
PY - 2013/4/26
Y1 - 2013/4/26
N2 - Background:The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia.Methods:We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy.Results:Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation.Conclusion:It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.
AB - Background:The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia.Methods:We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy.Results:Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation.Conclusion:It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.
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U2 - 10.1371/journal.pone.0061899
DO - 10.1371/journal.pone.0061899
M3 - Article
C2 - 23637925
AN - SCOPUS:84876854251
SN - 1932-6203
VL - 8
JO - PLoS One
JF - PLoS One
IS - 4
M1 - e61899
ER -