Beyond Febrile Neutropenia: Risks Associated with Antibiotic Choice in Children with Leukemia that Undergo Transplant
A subset of children with high-risk leukemia require stem cell transplant in order to cure their disease. Owing to the profound immunosuppression associated with this procedure, children undergoing transplant receive a substantial number of antibiotics. However, the implications of such extensive antibiotic exposures are not well understood.
This study proposes to evaluate the adverse events associated with antibiotics through complementary aims that specifically strive to understand if there is risk variability across classes of antibiotics that are otherwise considered interchangeable with regards to their anti-infectious properties. This proposal focuses on three common post-transplant complications that lead to significant morbidity: (1) graft-versus-host disease, the major immunologic complication of transplant, (2) clostridium difficile infection, an infection associated with considerable mortality in immunocompromised hosts; and (3) acute kidney injury, an organ toxicity that limits the delivery of other necessary post-transplant medications. Identification of differential risk with regards to one or more of these outcomes will be immediately actionable, factoring into decision-making about antibiotic choice by clinicians at the bedside. Through investigating the adverse outcomes associated with this common exposure, we can immediately influence clinical practice to promote rational and individualized antibiotic selection in children with leukemia, and limit the toxicity that is associated with cure.