Bacterial Infections in Children With Acute Myeloid Leukemia Receiving Ciprofloxacin Prophylaxis
Suha Al Omar1, Nadine Anabtawi, Wiam Al Qasem
1Departments of *Pharmacy †Pediatric Oncology, Pediatric Bone Marrow and Stem Cell Transplantation, King Hussein Cancer Center, Amman, Jordan.
Insights
Ciprofloxacin prophylaxis in pediatric acute myeloid leukemia (AML) patients led to a high incidence of bacterial infections, predominantly gram-positive. Reconsidering this prophylactic regimen is crucial for patient safety.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Assessing bacterial infections in pediatric patients with acute myeloid leukemia (AML) undergoing ciprofloxacin prophylaxis.
- Evaluating the efficacy of single-agent ciprofloxacin in preventing infections during AML treatment.
Purpose of the Study:
- To describe the incidence and types of bacterial infections.
- To identify common bacterial pathogens associated with ciprofloxacin prophylaxis in pediatric AML.
Main Methods:
- Retrospective review of 50 pediatric AML patients treated between 2011 and 2015.
- Analysis of medical records for positive cultures, infection types, isolated bacteria, and ICU admissions.
Main Results:
- 84% of patients experienced 77 bacterial infection episodes, with 45% requiring ICU admission.
- Gram-positive bacteria (62%) were the most common cause, followed by gram-negative (33%).
- Coagulase-negative Staphylococcus and Viridans streptococci were the most frequently isolated pathogens.
Conclusions:
- The AML02 protocol showed a high rate of bacterial infections, primarily gram-positive.
- Current prophylactic regimen requires reconsideration due to its limited efficacy.
- Alternative antibacterial prophylaxis strategies should be explored for pediatric AML patients.
Background:
The aim of the study was to describe the incidence and type of bacterial infections associated with the use of ciprofloxacin prophylaxis as single agent in pediatric patients with acute myeloid leukemia (AML).
Procedure:
This was a retrospective review of all patients with AML, who were treated according to the AML02 protocol between 2011 and 2015. The medical records were reviewed for any positive cultures from the initiation of the protocol until death or protocol discontinuation. Patient demographics, type of infections, type of isolated bacteria, and intensive care unit admissions were recorded.
Results:
A total of 50 patients were evaluated, who were of a mean age of 8 years±5.1 (SD). We identified 77 episodes of bacterial infections in 42 (84%) patients. Among those bacterial infections, 73 episodes were with bacteremia and included 45 (62%) gram-positive bacterial infections, 24 (33%) gram-negative bacterial infections, and 4 (6%) mixed gram-negative and gram-positive bacterial infections. Coagulase-negative Staphylococcus and Viridans streptococci were the most commonly isolated bacteria in 33% and 30% of the episodes, respectively. Seventeen (45%) patients with bacteremia required intensive care unit admission.
Conclusions:
A high rate of bacterial infection was detected in patients who received the AML02 protocol, mainly gram-positive bacterial infections. The prophylactic regimen should be reconsidered for its efficacy, and other antibacterial prophylaxis may be used.
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