TY - JOUR T1 - Incidence of bacteremias and invasive mycoses in children with acute non-lymphoblastic leukemia: results from a multi-center Italian study. JF - Pediatr Blood Cancer Y1 - 2010 A1 - Castagnola, Elio A1 - Rossi, Mario R A1 - Cesaro, Simone A1 - Livadiotti, Susanna A1 - Giacchino, Mareva A1 - Zanazzo, Giulio A1 - Fioredda, Francesca A1 - Beretta, Chiara A1 - Ciocchello, Francesca A1 - Carli, Modesto A1 - Putti, Maria Caterina A1 - Pansini, Valeria A1 - Berger, Massimo A1 - Licciardello, Maria A1 - Farina, Silvia A1 - Caviglia, Ilaria A1 - Haupt, Riccardo KW - Antineoplastic Combined Chemotherapy Protocols KW - Bacteremia KW - Child KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Italy KW - Leukemia, Myeloid, Acute KW - Male KW - Mycoses KW - Neoplasm Recurrence, Local KW - Retrospective Studies AB -

BACKGROUND: Data on the epidemiology of bacteremias and invasive fungal diseases (IFD) in children with acute myeloid leukemia (AML) are scarce.

DESIGN AND METHODS: In a multi-center, retrospective study, we analyzed proportion, rate per 1,000 person-days at risk, and cumulative risk of bacteremias and IFD in children with AML.

RESULTS: Between January 1998 and December 2005, 240 children were treated for AML at 8 Italian Centers, for a total of 521 treatment courses and 63,232 person-days at risk. Bacteremia was observed in 32% of treatment courses and IFD was seen in 10% (P < 0.0001), with rates of 2.62 and 0.84, respectively (P < 0.001). There was a significantly higher frequency of IFD during relapse treatment: proportion 15% versus 9% (P = 0.05), rate 2.10 versus 0.64 (P = 0.008) and cumulative risk 32% versus 12% (P = 0.007), while there were no differences in the proportion, rate and cumulative risk of bacteremia during front-line or relapse treatment. The epidemiology of bacteremias and IFD was different during front-line therapy for M3 as compared to other types of AML, but the differences were not statistically significant.

CONCLUSIONS: Severe infectious complications are frequent during the treatment of pediatric AML, especially during relapse treatment, and bacteremias are more frequent than IFD.

VL - 55 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20680968?dopt=Abstract ER - TY - JOUR T1 - Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. JF - Haematologica Y1 - 2010 A1 - Caselli, Désirée A1 - Cesaro, Simone A1 - Ziino, Ottavio A1 - Zanazzo, Giulio A1 - Manicone, Rosaria A1 - Livadiotti, Susanna A1 - Cellini, Monica A1 - Frenos, Stefano A1 - Milano, Giuseppe M A1 - Cappelli, Barbara A1 - Licciardello, Maria A1 - Beretta, Chiara A1 - Aricò, Maurizio A1 - Castagnola, Elio KW - Adolescent KW - Antineoplastic Agents KW - Bacteremia KW - Child KW - Child, Preschool KW - Drug Resistance, Multiple KW - Female KW - Hematopoietic Stem Cell Transplantation KW - Humans KW - Immunocompromised Host KW - Infant KW - Infant, Newborn KW - Italy KW - Male KW - Pseudomonas aeruginosa KW - Pseudomonas Infections KW - Retrospective Studies KW - Young Adult AB -

Pseudomonas aeruginosa is one leading gram-negative organism associated with nosocomial infections. Bacteremia is life-threatening in the immunocompromised host. Increasing frequency of multi-drug-resistant (MDRPA) strains is concerning. We started a retrospective survey in the pediatric hematology oncology Italian network. Between 2000 and 2008, 127 patients with Pseudomonas aeruginosa bacteremia were reported from 12 centers; 31.4% of isolates were MDRPA. Death within 30 days of a positive blood culture occurred in 19.6% (25/127) of total patients; in patients with MDRPA infection it occurred in 35.8% (14/39). In the multivariate analysis, only MDRPA had significant association with infection-related death. This is the largest series of Pseudomonas aeruginosa bacteremia cases from pediatric hematology oncology centers. Monitoring local bacterial isolates epidemiology is mandatory and will allow empiric antibiotic therapy to be tailored to reduce fatalities.

VL - 95 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20305140?dopt=Abstract ER -