From the *Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta; †Hematology/Oncology, Cancer Care Manitoba, Winnipeg, Manitoba; ‡Hematology/Oncology, Montreal Children's Hospital, Montréal, Quebec; §Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia; ¶Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario; ‖Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario; **Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, ††Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta; ‡‡Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario; §§Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, Ontario; ¶¶Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec; ‖‖Pediatrics, IWK Health Centre, Halifax, Nova Scotia; ***Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland; †††Hematology/Oncology, London Health Sciences, London, Ontario; ‡‡‡Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec; ¶§§§Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; and ¶¶¶¶Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Infect Dis J. 2014 Feb;33(2):126-9. doi: 10.1097/INF.0000000000000058.
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.
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.
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.
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.
草绿色链球菌（VGS）可导致接受急性髓系白血病（AML）治疗的儿童出现显著发病率。我们的目标是确定在接受 AML 治疗的儿童中这些感染的发生和影响，并了解增加该人群 VGS 感染和草绿色链球菌性休克综合征（VSSS）风险的因素。
我们进行了一项回顾性、基于人群的队列研究，该研究纳入了在加拿大 15 个中心接受治疗的≤18 岁的新发 AML 儿童。我们评估了与 VGS 感染和 VSSS 相关的因素。
在 341 例 AML 患儿中，78 例（22.9%）患儿在整个治疗过程中出现 VGS，16 例患儿出现复发。在 1277 例化疗疗程中，有 97 例（7.6%）发生了 VGS 感染。这些发作中有 19.6%发生了 VSSS，包括 11 名需要重症监护服务的患者，其中 2 例 VGS 感染导致死亡。在多变量回归分析中，与 VGS 相关的独立因素包括根据医学研究委员会方案治疗（比值比[OR] 2.87，95%置信区间[CI] 1.53-5.39；P = 0.001）、阿糖胞苷每克/平方米剂量（OR 1.04，95%CI 1.01-1.07；P = 0.002）和中性粒细胞减少症延长（OR 1.58，95%CI：0.97-2.56；P = 0.06）。评估的因素均与 VSSS 无关。
VGS 感染在化疗疗程中的发生率为 7.6%，仍是接受 AML 治疗的儿童发病率甚至死亡率的重要原因。需要确定减少 VGS 的干预措施。
