Children and adolescents with acute myeloid leukemia (AML) are at risk of life-threatening bacterial infections, especially with viridans group streptococci. Primary antibacterial prophylaxis with vancomycin-based regimens reduces this risk but might increase the risks of renal or liver toxicity or Clostridium difficile infection (CDI). We conducted a retrospective review of data from patients treated for newly diagnosed AML at St. Jude Children's Research Hospital between 2002 and 2008 was conducted. The central question— “Is vancomycin safe for AML patients?”— sounds fairly simple, but finding its answer required complex statistical modeling. By using advanced statistical modeling, we demonstrated that vancomycin not only prevented sepsis but also did not cause kidney or liver damage, even when sepsis was considered. This study reinforces that the current usage of vancomycin is safe, and it concluded that vancomycin-based prophylaxis in pediatric patients with AML does not increase the risk of nephrotoxicity or hepatotoxicity and reduces the risk of CDI. Furthermore, it also gives the field the impetus to study the proactive use of other antibiotics. The participating staff statistician’s intellectual efforts are acknowledged and he serves as the first author of the manuscript.
Sun Y.†, Huskey R.L., Tang L., Inaba H., Gaur A.H., Ribeiro R., Rubnitz J. and Wolf J. Adverse effects of intravenous vancomycin-based prophylaxis during therapy for pediatric acute myeloid leukemia. Antimicrobial Agents and Chemotherapy. 62(3):e01838-17, 2018. PMID: 29229640 DOI: 10.1128/AAC.01838-17 († Supervisee as the first author).