Infection Management in Pediatric AML

As reviewed in prior chapters, highly intensive treatment regimens have been involved in improving survival in pediatric patients with acute myeloid leukemia (AML). Despite these improvements, infections are responsible for a significant portion of treatment-related morbidity and mortality, with ranges of infection-related mortality from 6% to 11% (Sung et al., Pediatr Blood Cancer 51:458–460, 2008). The combination of treatment and host factors leads to a particularly high risk for infectious complications of therapy (Sung et al., Cancer 115(5):1100–1108, 2009). These factors include duration of intensive chemotherapy (often 6–9 months), duration of severe neutropenia per cycle, need for central line access, malnutrition, and risk of mucositis leading to increased risk for gut translocation (Patel and Green, Pediatric transplant and oncology infectious diseases, Elsevier, 2021). This chapter will review the principles around epidemiology, prophylaxis, diagnosis, and general concepts of empiric management of bacterial, fungal, and viral infections for children receiving therapy for AML (excluding the transplant period). We will also review more recent evidence around implications of infectious management and location of care in pediatric AML.