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Effectiveness and antimicrobial susceptibility profiles during primary antimicrobial prophylaxis for pediatric acute

Ting-Chi Yeh1, Jen-Yin Hou1, Ting-Huan Huang2

  • 1Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children's Hospital and Mackay Medical College, 92, Section 2, Chung-San North Road, Taipei, 104, Taiwan.

Scientific Reports
|October 28, 2021
PubMed

Insights

Antimicrobial prophylaxis in pediatric acute myeloid leukemia (AML) patients significantly reduced infections and improved survival rates. This strategy also lowered overall antimicrobial exposure, despite some resistance changes.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Hematology

Background:

  • Limited data exist on antimicrobial exposure and microbial evolution in pediatric acute myeloid leukemia (AML) patients receiving prophylaxis.
  • Assessing the impact of antimicrobial prophylaxis on infection rates, bacterial susceptibility, and drug exposure in pediatric AML is crucial.

Purpose of the Study:

  • To evaluate the effectiveness of antimicrobial prophylaxis in reducing infections and improving outcomes in pediatric AML patients undergoing chemotherapy.
  • To analyze changes in bacterial antibiotic susceptibilities and antimicrobial drug exposure during prophylaxis.

Main Methods:

  • A retrospective study of 90 pediatric AML patients (0-18 years) from 1997-2018.
  • Comparison of infection episodes (bloodstream infections - BSI, invasive fungal infections - IFI) and febrile neutropenia between pre-prophylaxis (1997-2009) and prophylaxis (2010-2018) periods.
  • Analysis of antimicrobial exposure and bacterial susceptibility patterns.

Main Results:

  • Antimicrobial prophylaxis significantly reduced BSI, IFI, and febrile neutropenia rates compared to no prophylaxis.
  • Exposure to certain antimicrobials (amikacin, carbapenem, amphotericin B) decreased during the prophylaxis period.
  • Reduced susceptibility was observed for Imipenem in Enterobacter cloacae and Vancomycin in Enterococcus species.
  • Patients receiving prophylaxis showed improved 5-year overall survival rates.

Conclusions:

  • Prophylactic antimicrobial administration in pediatric AML patients undergoing chemotherapy is effective in reducing life-threatening infections.
  • This strategy can decrease overall antimicrobial exposure and potentially lead to better patient outcomes.
  • Monitoring microbial evolution and resistance patterns is essential during antimicrobial prophylaxis.

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