对于接受丙胺培南预防治疗的急性髓系白血病（AML）儿童患者，其血流感染（BSI）的潜力尚未完全确定。通过对2010年至2018年期间在两所附属儿科三级医院内接收AML患者的回顾性准实验研究，研究过程中引入了丙胺培南预防治疗，该治疗适用于深度中性粒细胞减少的无发热AML患者。在预防组中，中性粒细胞减少期间的BSI发生率（每1000中性粒细胞减少日）明显低于基线组（2.6 vs 15.5，发病率比（IRR）为0.17， 95% CI 0.09 to 0.32）。间断时间序列（ITS）分析显示，BSI发生显著减少与预防治疗的实施同时发生。基线组中经常发生青年链球菌血症，但在引入预防治疗后未观察到该现象。尽管使用丙胺培南的频率增加了，但每1000中性粒细胞减少日的非敏感性（NS）BSI发病率降低了（1.6 vs 4.1，IRR 0.40， 95% CI 0.16 to 0.99）。预防组中每位患者的发热性中性粒细胞减少事件的中位数以及收治进重症监护病房（ICU）的患者比例均减少（22/51（43.1%）vs 26/38（68.4%）；风险差异-25.3%，95%CI -44.4 to -2.8）。观察到在预防组中，患者中患有难辨梭状芽孢杆菌感染（CDI）的比例有所增加（10/51（19.6%）vs 3/38（7.9%）；风险差异11.7%，95% CI -3.4 to 29.0）。对于儿科AML患者，丙胺培南预防治疗与BSI、发热性中性粒细胞减少和ICU入院的显著减少有关。 © The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The potential for cefepime prophylaxis to reduce bloodstream infections (BSIs) in pediatric patients with acute myelogenous leukemia (AML) has been incompletely characterized.A retrospective quasi-experimental study of patients under 21 years of age admitted with AML from 2010 through 2018 at two affiliated pediatric tertiary-care hospitals before and after adoption of routine cefepime prophylaxis for afebrile AML patients during profound neutropenia.The rate of BSIs per 1000 neutropenia days was significantly lower in the prophylaxis group than the baseline group (2.6 vs 15.5, incidence rate ratio (IRR) 0.17, 95% CI 0.09 to 0.32). Interrupted time series (ITS) analysis showed that a sharp reduction in BSIs coincided with the implementation of prophylaxis. Bacteremia with viridans group streptococci was frequent in the baseline group but not observed after adopting prophylaxis. Despite increased use of cefepime, the rate of cefepime-nonsusceptible (NS) BSIs per 1000 neutropenia days decreased (1.6 vs 4.1, IRR 0.40, 95% CI 0.16 to 0.99). The median number of febrile neutropenia episodes per patient also decreased in the prophylaxis group, as did the proportion of patients admitted to the intensive care unit (ICU) (22/51 (43.1%) vs 26/38 (68.4%); risk difference -25.3%, 95% CI -44.4 to -2.8). A trend was observed toward an increased proportion of patients with Clostridioides difficile infection (CDI) in the prophylaxis group (10/51 (19.6%) vs 3/38 (7.9%); risk difference 11.7%, 95% CI -3.4 to 29.0).Cefepime prophylaxis was associated with a significant reduction in BSIs, febrile neutropenia, and ICU admission among pediatric AML patients.© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.