Acute myeloid leukemia; bloodstream infections and supportive care
Mentor Name: Brian Fisher
In the past decade, advancement in supportive care measures have served to reduce the morbidity and mortality associated with intensive chemotherapy administered to children and adolescents with acute
myeloid leukemia (AML). A major change in supportive care during this time has been the routine use of antibiotic prophylaxis during periods of neutropenia. The institution of antibiotic prophylaxis as standard-of-care has led to the decline in rates of bloodstream infections (BSI) from approximately 40% of neutropenic periods to 20%. However, in recent years there has been anecdotal recognition for a rise in antibiotic resistance among pathogens that breakthrough prophylaxis. This has raised concerns about the unintended harm of prophylaxis and led some to question whether prophylaxis should remain routine. It is necessary to have systematic capture of BSIs across multicenter cohorts of pediatric AML. These foundational data will allow for descriptive epidemiology to characterize the current state of resistance for pediatric AML. To achieve this objective, this project will involve manual chart abstraction for an existing multi-institution cohort of pediatric AML patients established by investigators in the Pediatric Cancer Epidemiology Research Group at CHOP. We will capture the BSI events and the susceptibility testing across the range of antibiotics that each pathogen is tested against. These data will provide an opportunity for future comparative analyses of the impact of resistance among pathogens causing BSI on outcomes in this patient population.
