Antibiotic prophylaxis with teicoplanin on alternate daysreduces rate of viridans sepsis and febrile neutropenia in pediatric patients withacute myeloid leukemia

摘要

Intensive chemotherapy directed against acute myeloid leukemia of childhood is followed by profound neutropenia and high risk for bacterial and fungal infections, including viridans group streptococci as a common cause for gram-positive septicemia. Few retrospective studies have shown the efficacy of various antibiotic prophylactic regimens in children. We retrospectively studied 50 pediatric patients treated on the AML-BFM 2004 protocol between 2005 and 2015 at St. Anna Children’s Hospital and assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia and bacterial sepsis. Fifty pediatric patients underwent 199 evaluable chemotherapy cycles. Viridans sepsis occurred after none of 98 cycles with prophylactic administration of teicoplanin/vancomycin in comparison to 12 cases of viridans sepsis among 79 cycles without systemic antibacterial prophylaxis (0 vs. 15 %, p < 0.0001). In addition, there were significantly fewer episodes of febrile neutropenia in the teicoplanin/vancomycin group (44 % vs. no prophylaxis 82 %, p < 0.0001). Severity of infection seemed to be worse when no antibiotic prophylaxis had been administered with a higher rate of intensive care unit treatment (0/98, 0 %, vs. 4/79, 5 %, p = 0.038). So far, no increase of vancomycin-resistant enterococcus isolates in surveillance cultures was noticed. Antibiotic prophylaxis withteicoplanin (or vancomycin) appears safe and feasible and resulted in eradication ofviridans sepsis and decreased incidence of febrile neutropenia in pediatric AMLpatients. The possibility to administer teicoplanin on alternate days on anoutpatient basis or at home could contribute to patient’s quality of life anddecrease health care costs.Electronic supplementary materialThe online version of this article (doi:10.1007/s00277-016-2833-5) contains supplementary material, which is available to authorizedusers.