How common are gram-negative bloodstream infections in children with Acute Myeloid Leukemia?

Gram-negative bloodstream infections (GNBSI) are a serious complication in children receiving treatment for acute myeloid leukemia (AML). These infections can lead to severe illness and even death. Studies show that these infections are relatively common, especially during the first round of chemotherapy (induction). One large study from a children's cancer hospital found that about 27% of children had at least one GNBSI during induction, and most of those infections were resistant to multiple antibiotics ⁶. Another study reported that 33% of bacterial bloodstream infections were gram-negative ¹⁰, while a third study found that gram-negative bacteria caused 56% of bloodstream infections in children with AML ¹¹. The exact numbers vary, but the pattern is clear: GNBSI are a frequent and dangerous problem.

What the research says

A 2021 study from Egypt looked at 90 children with AML who had a GNBSI during induction chemotherapy. Out of 124 infection episodes, the most common bacteria were E. coli (54.8%), K. pneumoniae (16.9%), and A. baumannii (6.5%) ⁶. Alarmingly, 80% of these children had at least one multidrug-resistant (MDR) infection, meaning the bacteria did not respond to many common antibiotics ⁶. The 30-day death rate from these infections was 27.8% ⁶. Other complications included typhlitis (a serious gut infection) in 32% of children, removal of central venous catheters in 13%, and ICU admission in 42% ⁶.

Other studies confirm that gram-negative bacteria are a major cause of bloodstream infections in children with AML. A Chinese study from 2021 found that gram-negative bacteria caused 40% of bloodstream infections during first induction ⁹. A study from the United States reported that 33% of bacterial bloodstream infections were gram-negative in children receiving ciprofloxacin prophylaxis ¹⁰. A Taiwanese study found an even higher proportion: 56% of bloodstream infections were gram-negative ¹¹. The most common gram-negative bacteria across studies were E. coli, Klebsiella, and Pseudomonas ⁶¹¹.

These infections often occur when children have very low white blood cell counts (neutropenia). In one study, 73% of children with GNBSI had severe neutropenia ¹¹. The risk is highest during induction chemotherapy, when the immune system is most suppressed ⁶⁹.

What to ask your doctor

• What is the rate of gram-negative bloodstream infections at our hospital, and which bacteria are most common?
• Should my child receive antibiotics to prevent infections during chemotherapy, and if so, which ones?
• How does the hospital monitor for multidrug-resistant bacteria, and what steps are taken if one is found?
• What signs of infection should I watch for at home, and when should I seek emergency care?
• If my child develops a fever during treatment, how quickly will antibiotics be started?