Preventing Infections in Children with Cancer.

Abstract

1. Jennifer Lighter-Fisher, MD* 2. Kaitlin Stanley, MD* 3. Michael Phillips, MD† 4. Vinh Pham, MD, PhD† 5. Liana M. Klejmont, PharmD, BCPS‡ 1. *Department of Pediatrics, New York University Langone Medical Center, New York, NY. 2. †Department of Medicine, New York University Langone Medical Center, New York, NY. 3. ‡Department of Pharmacy, New York University Langone Medical Center, New York, NY. After completing this article, the reader should be able to: 1. Provide recommendations for bacterial prophylaxis for children experiencing severe and prolonged neutropenia. 2. Screen and recommend prophylaxis against Mycobacterium tuberculosis for children receiving immunosuppressive regimens. 3. Provide recommendations for secondary prophylaxis against Clostridium difficile infection, a common infection causing morbidity in the pediatric oncology population. 4. Recommend appropriate antifungal prophylaxis for pediatric patients who have high-risk cancers. 5. Review primary and second-line options for Pneumocystis jiroveci (carinii) pneumonia prophylaxis in children who fail trimethoprim/sulfamethoxazole therapy. 6. Prevent reactivation of viral infections in children receiving cancer treatment. 7. Screen for latent parasitic infections in newly diagnosed pediatric oncology patients. 8. Review vaccination regimens for patients receiving oncology treatment as suggested by the Infectious Diseases Society of America. Clear guidelines exist for the prevention of infections in patients undergoing hematopoietic stem cell transplantation (HSCT), (1)(2) but there is no guidance regarding prophylactic antimicrobial therapy for pediatric cancer patients receiving systemic chemotherapy. Infection, whether due to bacterial, fungal, viral, or parasitic pathogens, is a leading cause of morbidity and mortality in this patient population. (3)( 4)( 5) For example, more than 60% of children being treated for acute myeloid leukemia (AML) experienced at least 1 microbiologically documented infection during therapy, and the cumulative infectious mortality rate was 11%. (5) Therefore, infection prevention is of the utmost importance. Due to the lack of standard guidelines for infection prevention in most children being treated for cancer, current …