Medical Oncology

, 17:111

Infections in acute leukemia: an analysis of 240 febrile episodes

  • R Jagarlamudi
  • L Kumar
  • V Kochupillai
  • A Kapil
  • U Banerjee
  • S Thulkar
Original Paper

Abstract

Infections are the major cause of morbidity and mortality in acute leukemia patients. Case records of 91 consecutive patients (AML-48, ALL-40, RAEB-t/AML-3) treated between January 1997 and July 1999 were studied to determine the type, frequency and severity of infections. Patients' median age was 36 y (range 6–66) and male to female ratio was 2.5:1. A total of 240 febrile episodes were recorded; of them, 162 were associated with neutropenia (absolute neutrophil count, ANC<500/mm3) and 78 were without neutropenia.

Among the neutropenic episodes, an infectious etiology could be documented in 52%; the remainder (485) were defined as isolated febrile episodes. Chest was the most common site of infection (35.7%) followed by skin, soft tissue (13%), GIT (7%) and genitourinary tract (6%) infections in order of decreasing frequency. Microbiologically, gram positive organisms (staphylococcus aureus, coagulase negativestaphylococcus, streptococcus, enterococcus) were the most common isolates (52.8%) followed by gram negative organisms (E. coli, klebsiella, pseudomonas) in 42.8% of isolates. Two patients had pulmonary tuberculosis and three patients had fungal infections (candida—2,aspergillus—1).

Among non-neutropenic patients, infection could be documented in 36%; the remaining 64% were isolated febrile episodes. Gram negative infections were documented in 50%, gram positive in 305 and fungal infections (candia—4,aspergillus—1,mucormycosis—1) in 20% of them.

A combination of third generation cephalosporin and an aminoglycoside were used in 79% of episodes initially; a combination of a newer, penicillin and aminoglycoside (4.6%), double betalactums (4.1%), oral, antibiotics (9.8%) and others were used in the remaining episodes. Fever resolved in 38%, of episodes using the above combinations; in the remainder second line antibiotics (mainly vancomycin) and antifungals (amphotericin-B) were added empirically or depending on culture and sensitivity. In 52.5% of episodes fever resolved after addition of second line antibiotics and antifungals. 11 of 91 patients died of infectious complications in this study. There is a need for improvised diagnostic tests to detect infections early, as well as for new therapies to overcome antimicrobial resistance.

Keywords

acute leukemia neutropenia bacterial infections treatment 

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Copyright information

© Macmillan Publishers Ltd All rights reserved 2000

Authors and Affiliations

  • R Jagarlamudi
    • 3
  • L Kumar
    • 3
  • V Kochupillai
    • 3
  • A Kapil
    • 1
  • U Banerjee
    • 1
  • S Thulkar
    • 2
  1. 1.Department of Microbiology, Institute Rotary Cancer HospitalAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of Medical Radiology, Institute Rotary Cancer HospitalAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of Medical Oncology, Institute Rotary Cancer HospitalAll India Institute of Medical SciencesNew DelhiIndia

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