Conflict of interest: Nothing to declare.
High frequency of streptococcal bacteraemia during childhood AML therapy irrespective of dose of cytarabine†
Article first published online: 31 DEC 2012
Copyright © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 60, Issue 7, pages 1154–1160, July 2013
How to Cite
Johannsen, K. H., Handrup, M. M., Lausen, B., Schrøder, H. and Hasle, H. (2013), High frequency of streptococcal bacteraemia during childhood AML therapy irrespective of dose of cytarabine. Pediatr. Blood Cancer, 60: 1154–1160. doi: 10.1002/pbc.24448
- Issue published online: 22 MAY 2013
- Article first published online: 31 DEC 2012
- Manuscript Accepted: 27 NOV 2012
- Manuscript Received: 18 SEP 2012
- Danish Childhood Cancer Foundation
- acute myeloid leukaemia;
- viridans group streptococci
High-dose cytarabine has been associated with a high frequency of viridans group streptococcal (VGS) bacteraemia. VGS bacteraemia causes considerable morbidity and mortality. The Nordic Society of Paediatric Haematology and Oncology (NOPHO)-AML protocols use higher cumulated doses of cytarabine and more chemotherapy series (n = 6) than other protocols with the potential increased risk of severe VGS infections.
Medical records of all Danish children enrolled on the NOPHO-AML-2004 protocol between January 2004 and September 2011 (n = 45) were retrospectively reviewed and all febrile episodes were registered.
Following 236 courses of chemotherapy, 112 positive blood cultures were registered. VGS were found in 38% of all positive blood cultures. Infectious episodes with VGS resulted in more days of fever and intravenous antibiotic therapy compared with infections caused by other microorganisms. VGS were involved in 45% of all episodes categorized as sepsis (n = 51) and in 67% of life-threatening bloodstream infections (n = 9). Penicillin resistance was found in 40% of the VGS strains. No significant difference was observed in the proportion of VGS isolated following courses with low-dose cytarabine versus courses with high-dose cytarabine.
VGS were the most commonly isolated pathogens causing the most severe infections and the majority of life-threatening infections. A substantial proportion of the strains were resistant to penicillin. The high rate of VGS seemed independent of high-dose cytarabine but was more likely caused by the intensive chemotherapy treatment leading to severe mucositis and neutropenia. Pediatr Blood Cancer 2013; 60: 1154–1160. © 2012 Wiley Periodicals, Inc.