Combating blood stream infections during induction chemotherapy in children with acute myeloid leukemia: Single center results in India

Subburaj, Divya; Uppuluri, Ramya; Jayaraman, Dhaarani; Vellaichamyswaminathan, Venkateshwaran; Kandath, Sathish; Raj, Revathi

doi:10.1002/pbc.26517

Cited by 5 publications

(9 citation statements)

References 15 publications

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“…among Gram-negatives. 18,20 Outcome results were encouraging since only 2 of 224 BSI episodes were fatal showing a low mortality rate (0.9%). This rate is comparable, if not better, with recent reports estimating the mortality of BSI among children with cancer at 2% to 2.7%.…”

Section: Discussionmentioning

confidence: 96%

“…Nevertheless, in line with the previous literature, our study showed also that the predominant bacteria isolated in children with cancer were CoNS among the Gram-positive ones and E. coli and Pseudomonas spp. among Gram-negatives 18,20…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…BSIs represent a significant cause of morbidity in children with cancer often resulting in longer duration of hospitalization, treatment delays, and prolonged use of broad-spectrum antibiotics. 17,18 In the current era of widespread antimicrobial resistance, early prediction of bacteremia, and the type of bacteria causing it may be of great importance for the selection of appropriate antibiotic treatment, improvement of clinical outcome and for lowering the risk of antimicrobial resistance. In the present study, focusing only on bacteremic episodes of infection, we found that hematologic malignancy, higher CRP levels and female sex were useful variables for the early prediction of Gram-negative versus Gram-positive bacteremia in febrile children with cancer.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer

Sfetsiori

Doganis²,

Doudoulakakis

et al. 2021

Journal of Pediatric Hematology/Oncology

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Background: Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment.Materials and Methods: Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria.Results: Among 224 monomicrobial bacterial BSI episodes, Gramnegative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P = 0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P = 0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P = 0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P = 0.009, neutrophils, P = 0.009 and platelets, P = 0.002, but with significantly higher C-reactive protein (CRP) levels, P = 0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis.Conclusions: Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer

Sfetsiori

Doganis²,

Doudoulakakis

et al. 2021

Journal of Pediatric Hematology/Oncology

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“…In addition, because of overcrowding and a lack of antibiotic stewardship in LMICs, there is a higher incidence of multidrug-resistant infection that requires the use of more antibiotics and increases the costs of supportive care. 6…”

Section: Introductionmentioning

confidence: 99%

Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists

Revon‐Rivière

Banavali

Heississen

et al. 2019

JGO

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PURPOSE Low- and middle-income countries (LMICs) experience the burden of 80% of new childhood cancer cases worldwide, with cure rates as low as 10% in some countries. Metronomics combines frequent administrations of low-dose chemotherapy with drug repurposing, which consists of using already-approved drugs for new medical applications. With wide availability, limited costs, and little infrastructure needs, metronomics can be part of constraint-adapted regimens in these resource-limited settings—with the understanding that metronomics shall not be a substitute for standard treatments when available and doable. Our study aims to describe the experience, practices, opinions, and needs in metronomics of physicians working in LMICs. METHODS An online questionnaire was sent to more than 1,200 physicians in pediatric oncology networks in LMICs. Items included the type of center, physician’s demographics, experience in pediatric oncology, and experience with current knowledge of metronomics. Opinions and perspectives were explored using multiple-answer and open questions. RESULTS Of physicians, 17% responded. Of respondents, 54.9% declared that they had already used a metronomic regimen. The most frequently cited repositioned drugs were celecoxib (44%) followed by propranolol and valproic acid (17%). Respondents highlighted the advantages of outpatient use (20%) and expected low toxicity (24%). In considering the drawbacks of metronomics, 47% of responses highlighted the lack of scientific evidence or guidelines, 33% the availability or affordability of drugs, and 18% the problem of acceptance or compliance. Of physicians, 79% believed that use of metronomics will spread in LMICs in the near future and 98% of them were willing to participate in international metronomic protocols or registries. CONCLUSION Metronomics is already used in LMICs and is a potential answer to unmet needs in pediatric oncology. There is room for improvement in the availability of drugs and a necessity to develop collaborative protocols and research to generate level A evidence.

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Therapeutic Strategies to Ameliorate Antibiotic Resistance and Host-Inflammation Response in Sepsis: an Innovative Approach

Shrivastava

Gothalwal

Gandhi

2023

Curr Clin Micro Rpt

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Combating blood stream infections during induction chemotherapy in children with acute myeloid leukemia: Single center results in India

Cited by 5 publications

References 15 publications

Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer

Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer

Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists

Therapeutic Strategies to Ameliorate Antibiotic Resistance and Host-Inflammation Response in Sepsis: an Innovative Approach

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