Infections in children with acute lymphoblastic leukemia

Provedeno je retrospektivno istraživanje infektivnih komplikacija u pacijenata oboljelih od akutne limfatične leukemije (ALL), liječenih prema ALL IC-BFM protokolu od 2016. do 2020. godine na Zavodu za hematologiju, onkologiju i kliničku genetiku Kliničkog bolničkog centra Rijeka. U istraživanje je bilo uključeno 23 djece (16 dječaka i 7 djevojčica) s ALL-om, 20 intermedijarnog rizika i 3 visokog rizika. Prosječna dob bila je 5,9 godina (raspon 1,2 – 12,2 godine). Svi su pacijenti imali ugrađen centralni venski kateter i svi su primali oralni trimetoprim/sulfametoksazol za profilaksu Pneumocystis jiroveci pneumonije. Obrađene su 104 infektivne epizode (IE): 1 pacijent je imao 1 IE, 3 pacijenta 2 IE, a 19 pacijenata je imalo ≥ 3 IE (prosječno 4,5 IE po pacijentu). IE su najčešće bile dokumentirane tijekom faze rane intenzifikacije. Neutropenija je bila prisutna u 48 IE (46,15%), s trajanjem duljim od 7 dana u 28 epizoda (58,33%). Respiratorni trakt je bio najčešće sijelo infekcije (48,08%), a slijedi ga gastrointestinalni trakt (8,65%). Identificirano je bilo 49 izolata bakterija (47,12%), 4 virusna (3,85%), 4 gljivična (3,85%), 10 miješanih (9,6%), a u 37 IE (35,6%) patogen nije bio identificiran. Glavni uzročnici bakterijemije bili su koagulaza-negativni stafilokoki. Najčešća empirijska terapija bili su cefalosporini treće i četvrte generacije, a slijedi piperacilin/tazobaktam. Modifikacija prve linije antimikrobne terapije bila je potrebna u 58 IE (56,9%). Granulocitni čimbenik rasta bio je primijenjen u 56 IE (53,85%), a intravenski imunoglobulini u 65 IE (62,5%). Jedan pacijent je zahtijevao prijem na jedinicu intenzivnog liječenja. Nije zabilježena smrtnost povezana s infekcijom.This is a retrospective study of infectious complications in patients with acute lymphoblastic leukemia (ALL) treated in ALL IC-BFM protocol from 2016 to 2020 at the Division of Hematology and Oncology, Department of Pediatrics, Clinical Hospital Centre Rijeka. Twenty-three children (16 boys and 7 girls) with ALL (20 intermediate risk and 3 high risk-ALL) were included in the study. The median age was 5.9 years (range 1.2 – 12.2 years). All patients had implanted central venous catheters and were receiving oral trimethoprim/sulfametoxazole for Pneumocystis jiroveci pneumonia prophylaxis. We verified 104 infectious episodes (IE): 1 patient had 1 IE, 3 patients had 2 IE, and 19 patients had ≥3 IE (average 4.5 IE/patient). IE were mostly observed during the early intensification phase. Neutropenia was present in 48 IE (46.15%), with duration longer than 7 days in 28 episodes (58.33%). Respiratory tract was the most common site of infection (48.08%), followed by gastrointestinal tract (8.65%). There were 49 bacterial isolates (47.12%), 4 viral (3.85%), 4 fungal (3.85%), 10 mixed (9.6%), and in 37 IE (35.6%) associated pathogen was not identified. The main cause of bacteriemia were coagulase-negative staphylococci. The most common empiric therapy was third- and fourth-generation cephalosporins, followed by piperacillin/tazobactam. Modification of first-line antimicrobial therapy was required in 58 IE (56.9%). Granulocyte colony stimulating factor was administered in 56 IE (53.85%), and intravenous immunoglobulins in 65 IE (62.5%). One patient required admission to the intensive care unit. No infection-related death was observed