Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia.

BACKGROUND: Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia. METHODS: Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines. RESULTS: Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different. CONCLUSION: For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.

Effects of feeding endophyte infected tall fescue seed on reproductive performance of female CD-1 mice via competitive breeding.

This study was conducted to determine the effects of feeding endophyte-infected (Acremonium coenophialum ) tall fescue (Festuca arundinacea ) seed on the growth and reproductive performance of female CD-1 mice via competitive breeding. One hundred sixty female mice were randomly allocated to groups of ten and fed one of two diets. Diet 1 consisted of 50% mouse chow and 50% noninfected Ky-31 tall fescue seed (w/w). Diet 2 contained 50% chow and 50% tall fescue seed that was 80% infected with A. coenophialum . After 50 d of preconditioning on their respective diets, a single male was introduced into each group of 10 females and allowed to cohabitate for 96 h. The males were removed after the cohabitation period and the females continued through gestation on their respective diets. Body weight of dams and litter weights were recorded at parturition. There were no differences (P>0.05) in pregnancy rates between dietary Treatments 1 and 2 (50% vs 48.8%, respectively). However, the average number of pups born per litter (11.10 pups) and average total litter weight (17.21 g) was greater for those females consuming Diet 1 than for females consuming Diet 2 (9.33 pups per litter and 13.97 g total litter weight). The incidence of dead and cannibalized pups was more frequent with Diet 2 than Diet 1 (0.13 vs 0.0 dead; 0.21 vs 0.03 cannibalized, respectively). The obtained data suggest that although the pregnancy rate was similar between the two dietary treatments, the reproductive capacity (litter size and litter weight) of female CD-1 mice was affected by the consumption of endophyte infected fescue seed.