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Cefepime and mortality in pediatric acute myelogenous leukemia: a retrospective cohort study

Brian T Fisher1, Richard Aplenc, Russell Localio

  • 1Division of Infectious Diseases, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. fisherbria@email.chop.edu

The Pediatric Infectious Disease Journal
|October 28, 2009
PubMed

Insights

Cefepime use in pediatric acute myelogenous leukemia (AML) patients did not increase mortality risk compared to other beta-lactam antibiotics. This study found no significant difference in survival rates for children treated with cefepime.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • The U.S. Food and Drug Administration (FDA) warned of potential cefepime risks in 2009.
  • Pediatric acute myelogenous leukemia (AML) patients frequently experience fever, requiring antibiotics like cefepime.
  • This study investigates cefepime's association with mortality in pediatric AML.

Purpose of the Study:

  • To evaluate the association between cefepime exposure and all-cause in-hospital mortality in pediatric AML patients.
  • To compare cefepime's safety profile against other beta-lactam antibiotics in this vulnerable population.

Main Methods:

  • Retrospective cohort study utilizing the Pediatric Health Information System database.
  • Examined exposure to cefepime, ceftazidime, antipseudomonal penicillin, and carbapenems within the first year of AML diagnosis.
  • Employed Cox regression analysis, adjusting for clinical and demographic factors, with analysis split into 0-3 and >3-12 month periods.

Main Results:

  • No significant differences in hazard ratios for mortality were observed between cefepime and ceftazidime, antipseudomonal penicillin, or carbapenems in either the 0-3 month or >3-12 month periods.
  • Hazard ratios (HR) and 95% confidence intervals (CI) showed no increased risk for cefepime across comparisons and timeframes.

Conclusions:

  • Cefepime exposure within 30 days of death did not elevate mortality risk in pediatric AML patients.
  • The findings suggest cefepime is a safe alternative to other beta-lactam antibiotics in this patient group.
Abstract

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