Prophylactic antibiotics lower infection risk in children with acute myeloid leukemia: Study

Taiwan: According to a new study, prophylactic antimicrobial administration in children with acute myeloid leukemia (AML) who are undergoing chemotherapy can considerably lower the incidence of life-threatening infection, antimicrobial exposure, and may result in a better outcome. The findings of this work were published in Nature's Scientific Reports.

There is a scarcity of data on antibiotic exposure and microbiological evolution in juvenile acute myeloid leukemia patients who received antimicrobial prophylaxis. Considering this, Ting-Chi Yeh and the team aimed to evaluate the efficacy of antimicrobial prophylaxis, antibiotic susceptibility of microorganisms, and antimicrobial exposure during intense treatment for AML patients. 

Between January 1, 1997, and March 31, 2018, 90 consecutive de novo AML patients aged 0–18 years were included in this trial. Prophylactic vancomycin, ciprofloxacin, and voriconazole administration began on January 1, 2010. 62 individuals reported 87 bouts of bloodstream infection (BSI) and 17 episodes of invasive fungal infection (IFI) among 502 sessions of chemotherapy during the pre-prophylaxis phase, from January 1997 to December 2009.

The results of this study stated as follows:

1. In contrast, in 28 patients who had 247 cycles of chemotherapy throughout the prophylactic period, 16 instances of BSI occurred and no IFIs were documented.

2. Individuals who received antimicrobial prophylaxis had significantly lower rates of BSI, IFI, and febrile neutropenia as compared to patients who did not get prophylaxis.

3. During the prophylactic period, amikacin, carbapenem, and amphotericin B exposure was decreased. During the prophylactic period, Enterobacter cloacae's imipenem susceptibility and Enterococcus species' vancomycin susceptibility were lowered.

4. Patients who received prophylaxis had a higher subsequent 5-year overall survival rate than those who did not get prophylaxis at the time of the final follow-up.

Finally, the current study adds to the body of knowledge by contrasting prophylaxis with antimicrobials in children with AML who did not get prophylaxis. Antimicrobial prophylaxis was observed to dramatically lower the risk of BSIs and IFIs in patients following intense chemotherapy. These findings indicate the relevance of antibiotic and antifungal prophylaxis in preventing treatment-related morbidities in children with AML, particularly BSIs and IFIs.

Reference:

Yeh, TC., Hou, JY., Huang, TH. et al. Effectiveness and antimicrobial susceptibility profiles during primary antimicrobial prophylaxis for pediatric acute myeloid leukemia. Sci Rep 11, 21142 (2021). https://doi.org/10.1038/s41598-021-00725-5