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Adverse Effects of Intravenous Vancomycin-Based Prophylaxis during Therapy for Pediatric Acute Myeloid Leukemia

Yilun Sun1, Rachael L Huskey2,3, Li Tang1

  • 1Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Antimicrobial Agents and Chemotherapy
|December 13, 2017
PubMed

Insights

Vancomycin-based prophylaxis for pediatric acute myeloid leukemia (AML) patients did not increase kidney or liver toxicity. This treatment also reduced Clostridium difficile infection (CDI) risk, offering a safer approach to infection prevention.

Area of Science:

  • Pediatric Hematology Oncology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Children and adolescents with acute myeloid leukemia (AML) face high risks of severe bacterial infections, particularly from viridans group streptococci.
  • Primary antibacterial prophylaxis, often vancomycin-based, is used to mitigate infection risk but raises concerns about potential toxicities and Clostridium difficile infection (CDI).

Purpose of the Study:

  • To evaluate the safety and efficacy of vancomycin-based prophylaxis in pediatric patients with newly diagnosed AML.
  • To compare the risks of nephrotoxicity, hepatotoxicity, and CDI associated with vancomycin-based prophylaxis versus no prophylaxis or other prophylactic regimens.

Main Methods:

  • Retrospective review of data from 111 pediatric patients with newly diagnosed AML treated between 2002 and 2008.
  • Assessment of nephrotoxicity using pediatric risk, injury, failure, loss, and end-stage renal disease (pRIFLE) criteria and hepatotoxicity using Common Terminology Criteria for Adverse Events (CTCAE).
  • Statistical analysis using generalized linear mixed models to compare outcomes between prophylaxis groups, adjusting for confounders.

Main Results:

  • Vancomycin-based prophylaxis was not associated with increased nephrotoxicity or hepatotoxicity in pediatric AML patients.
  • Patients receiving vancomycin-based prophylaxis had a significantly lower risk of CDI compared to those receiving no intravenous prophylaxis (0.9% vs. 6.5%, P = 0.007).
  • The risk of CDI was also lower, though not statistically significant, compared to other prophylactic regimens (0.9% vs. 3.0%, P = 0.23).

Conclusions:

  • Vancomycin-based prophylaxis is a safe and effective strategy for reducing infection risk in pediatric AML patients, without increasing renal or liver toxicity.
  • This prophylaxis regimen significantly reduces the incidence of Clostridium difficile infection (CDI).
  • While effective, continued caution is advised to prevent the development of antibiotic resistance.

Keywords:
Clostridium difficileacute kidney injuryantibioticchildleukemiamyeloidprophylaxisvancomycin

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