1095. Bloodstream Infections in Neutropenic Patient with Acute Leukemia: Frequency and Outcomes
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • BSI IDSA 2011 Poster 10-10-2011.pdf (327.7 kB)
  • Background: Bloodstream infections (BSI) are common in neutropenic leukemia patients and are a major cause of mortality. Empiric treatment of newly febrile neutropenic patients with broad spectrum antibiotics has reduced dramatically infection-related mortality. 

    Methods: Medical records of 253 patients with acute leukemia (190 AML 39 ALL 22 APL) who received induction chemotherapy at Univ. of Maryland Greenebaum Cancer Center between 2002-2006 were reviewed. Anti-infectives prescribed with onset of fever in neutropenic patients were reviewed. Responses were assessed by survival 4 weeks after initiation of anti-infective therapy. Deaths were reviewed for attribution to BSI.  

    Results: 169 of 253 patients had 394 BSI (280 Gram+, 141 gram negative rod (GNR), 21 fungal) during a total of 631 episodes of neutropenia. 42 blood cultures were polymicrobial. There were 26 Pseudomonas, 14 Acinetobacter, 21 fungal, and 8 S. aureus BSI. 17 of 93 patients with GNR BSI died within 4 weeks of the positive blood culture. GNR infections contributed to deaths of 11 of these patients. Similarly, 4 of 21 patients with fungal BSI and 31 of 151 patients with Gram+ BSI died within 4 weeks. Infections contributed to deaths of 2 and 7 patients with fungal and Gram+ BSI, respectively. 13 of the 20 infection-associated deaths occurred in patients with refractory or relapsed leukemia. Of the 17 patients with GNR BSI who died, 8 were bacteremic with GNR resistant to one or more of cefepime, piperacillin/tazobactam, or imipenem.

    Conclusion: Outcomes of BSI in neutropenic fever are derived from large randomized trials comparing efficacy of antibacterials in single neutropenic episodes in leukemia patients. Rates of mortality attributable to infection vary from 0.5 to 2.0%. Relapsed leukemia patients and those previously enrolled were not represented in these studies. In clinical practice, patients with leukemia, in remission and relapsed, become neutropenic and are treated for suspected or proven infections many times. Our study shows that remission status of the leukemia and resistance to first-line antibacterials contribute to infection-associated mortality which are not accounted for in the large randomized trials that have defined how we treat febrile neutropenia.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Michael Vincent Tablang, University of Maryland Medical Center, Baltimore, MD, Daniel Morgan, MD, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD and Michael Kleinberg, MD, University of Maryland School of Medicine, Baltimore, MD

    Disclosures:

    M. V. Tablang, None

    D. Morgan, None

    M. Kleinberg, None

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