451. Viridans streptococcal sepsis: clinical features and complications in childhood acute myeloid leukemia.
- Author
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Okamoto Y, Ribeiro RC, Srivastava DK, Shenep JL, Pui CH, and Razzouk BI
- Subjects
- Acute Disease, Adolescent, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Child, Preschool, Chromosome Aberrations, Combined Modality Therapy, Cytarabine administration & dosage, Daunorubicin administration & dosage, Deoxyadenosines administration & dosage, Double-Blind Method, Etoposide administration & dosage, Female, Granulocyte Colony-Stimulating Factor administration & dosage, Granulocyte-Macrophage Colony-Stimulating Factor administration & dosage, Hematopoietic Stem Cell Transplantation, Humans, Hypotension etiology, Immunocompromised Host, Leukemia, Myeloid drug therapy, Leukemia, Myeloid genetics, Leukemia, Myeloid therapy, Male, Mycoses complications, Neutropenia chemically induced, Neutropenia complications, Randomized Controlled Trials as Topic, Respiratory Distress Syndrome etiology, Retrospective Studies, Sepsis complications, Streptococcal Infections complications, Leukemia, Myeloid complications, Sepsis microbiology, Streptococcal Infections microbiology, Viridans Streptococci
- Abstract
Purpose: Treatment of acute myeloid leukemia (AML) is associated with substantial adverse effects, including neutropenia and infection. Viridans streptococci (VS) are a primary cause of infection and pneumonia in patients with neutropenia. The authors determined the incidence, clinical features, and complications of VS sepsis in children receiving chemotherapy for AML., Methods: The authors retrospectively reviewed the records of 172 patients treated on their institutional protocols AML91 (n = 95) and AML97 (n = 77) and identified 36 patients who had VS sepsis., Results: The 1-year cumulative incidence of VS sepsis was significantly higher in AML97 than in AML91. Patients with favorable cytogenetic features (ie, t(9;11), t(8;21), or inv(16)) had a significantly higher incidence of infection than did other patients. VS sepsis developed at various times after chemotherapy was initiated, and patients remained febrile for a median of 15 days. Twelve patients (33%) experienced hypotension, 10 (28%) acute respiratory distress syndrome, and 6 (17%) fungal infection. Twenty-three patients (64%) required intensive care, 21 (58%), oxygen therapy, and 7 (19%), vasopressor medications. One patient died of pulmonary aspergillosis after VS sepsis. The 3-year cumulative incidence of aspergillosis was higher in patients with VS sepsis than in those without., Conclusions: Although antibiotic therapy rapidly resolved VS sepsis, complications associated with this infection remained life-threatening in children receiving chemotherapy for AML.
- Published
- 2003
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