Corticosteroids increase infections in pediatric AML
Last Updated: 2012-09-11 14:25:18 -0400 (Reuters Health)
By Will Boggs MD
NEW YORK (Reuters Health) - Corticosteroids were associated with higher rates of infection, sepsis, and infectious death in a recent study of children with acute myeloid leukemia (AML).
"Systemic corticosteroids, even when used for short periods of time, may have important negative consequences, and thus, clinicians should try to avoid administering steroids whenever possible," Dr. Lillian Sung from The Hospital for Sick Children in Toronto told Reuters Health by email.
Her group reported online September 5 in Clinical Infectious Diseases on a population-based retrospective cohort study of children with newly diagnosed AML.
Nearly two-thirds of the children (218, 63.9%) experienced at least one sterile site microbiologically documented infection, 185 (54.3%) had bacteremia, and 263 (77.1%) had a clinically documented infection.
Among 1,277 courses of chemotherapy, 313 were associated with at least one sterile site infection (24.5%), 97 with sepsis (7.6%), and 16 with infectious deaths (1.3%). The median number of days with corticosteroid administration was two per course of chemo.
In multiple regression analysis, the duration of corticosteroid exposure was an independent risk factor for microbiologically documented sterile site infection, bacteremia, clinically documented infection, and sepsis.
Prolonged neutropenia and duration of corticosteroid exposure were both independent risk factors for sepsis, but only duration of corticosteroid use was associated with infectious death.
Cytarabine dose was also independently associated with sterile site infection and bacteremia, especially from Gram-positive organisms.
"While corticosteroid exposure has previously been determined to be a risk factor for invasive fungal infections, the relationship with other infection outcomes is less well recognized," the researchers note.
"Infections continue to be a major problem for children with AML in spite of our best supportive care, and children continue to die because of them," Dr. Sung said. "Further research will need to focus on reducing infections and better understanding why they occur in some children and not in others."
"We are currently conducting a large randomized controlled trial to determine if prophylactic caspofungin can reduce invasive fungal infection more than fluconazole," Dr. Sung said. "We will be able to evaluate how this effect is influenced by steroid exposure."
Clin Infect Dis 2012.
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