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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000058
Original Studies

Predictors and Outcomes of Viridans Group Streptococcal Infections in Pediatric Acute Myeloid Leukemia: From the Canadian Infections in AML Research Group

Lewis, Victor MD*; Yanofsky, Rochelle MD; Mitchell, David MD; Dix, David MD§; Ethier, Marie-Chantal BSc; Gillmeister, Biljana MSc; Johnston, Donna MD; Michon, Bruno MD**; Stobart, Kent MD††; Portwine, Carol MD‡‡; Silva, Mariana MD§§; Cellot, Sonia MD¶¶; Price, Victoria MB ChB‖‖; Bowes, Lynette MD***; Zelcer, Shayna MD†††; Brossard, Josee MD‡‡‡; Beyene, Joseph PhD¶ §§§; Sung, Lillian MD¶ ¶¶¶

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Abstract

Background:

Viridans group streptococci (VGS) cause significant morbidity in children treated for acute myeloid leukemia (AML). Our goals were to determine the occurrence and impact of these infections in children treated for AML and to understand the factors that increase the risk of VGS infections and viridans streptococcal shock syndrome (VSSS) in this population.

Methods:

We conducted a retrospective, population-based cohort study that included children ≤18 years of age with de novo AML treated at 15 Canadian centers. We evaluated factors related to VGS infection and VSSS.

Results:

Among 341 children with AML, VGS occurred in 78 (22.9%) children over the entire course of therapy and 16 had recurrent episodes. VGS infection occurred in 97 of 1277 courses of chemotherapy (7.6%). VSSS occurred in 19.6% of these episodes and included 11 patients who required intensive care services with 2 VGS infections resulting in death. In multiple regression analysis, factors independently related to VGS included treatment on a Medical Research Council-based protocol (odds ratio (OR) 2.87, 95% confidence interval (CI) 1.53–5.39; P = 0.001), cytarabine dose per gram/m2 (OR 1.04, 95% CI 1.01–1.07; P = 0.002) and prolonged neutropenia (OR 1.58, 95% CI: 0.97–2.56; P = 0.06). None of the evaluated factors were predictive of VSSS.

Conclusions:

VGS infections occur in 7.6% of chemotherapy courses and remain an important cause of morbidity and even mortality in children being treated for AML. Interventions to reduce VGS need to be identified.

Copyright © 2013 by Lippincott Williams & Wilkins

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