#15: Risk Factors of Infection related mortality in Pediatric Acute Myeloid Leukemia- Single Institute Experience: 2016–2018

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S1-S1
Author(s):  
Ahmed Bayoumi
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Infectious Complications ◽  
P Value ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Febrile Episodes ◽  
Acute Myeloid

Abstract Children with acute myeloid leukemia (AML) are at a particularly high risk for infectious complications related to the highly intensive chemotherapy. Infections leads to mortality and prolong hospitalization. The aim of the study is to evaluate the risk factors, infectious complications and assess outcome of febrile episodes during induction and consolidation chemotherapy courses in children with AML at the Pediatric Oncology Department, National Cancer Institute, Cairo University from January 2016 to December 2018. Infectious complications were evaluated retrospectively in 621 febrile episodes. Mortality from gram negative bacteremia was 29.9%, in febrile episodes with multidrug resistant gram negative bacteremia: Mortality was 39.2 % in febrile episodes with multidrug resistant gram negative bacteremia and septic shock. Mortality was 71.8 % (p value <0.001). Mortality was high in early chemotherapy phase (intensive timing). Infection related mortality was 39%. In our institute there is epidemiological shift towards gram negative organisms. Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of pediatric Acute myeloid leukemia. It is Important to trace the risk factors that may affect the outcome of febrile episodes. Summary of Significant laboratory and clinical predictors of mortality Risk Factor Mortality p value Septic shock 55% <0.001 Septic shock with MDRO 72% Cardiac impairment/inotropic support 65.60% Presence Of Central venous line 18.30% Episode duration >18 days 20.50% Start of antimicrobial in relation to start of chemotherapy < 16 days 33% Episodes: Not in remission 15.60% Risk factor Mortality p value CRP more than or equals 90 mg/l 24.4% Not significant ANC LESS THAN 500 29.9% 0.003 Hgb less than or equals to 7 g/dl 19.9% 0.633 Platelets less than 20000/cc 29.9% 0.299 Liver impairment (grades 3 and 4) 42.2% 0.025 Electrolyte imbalance (grades 3 and 4) 24.1% 0.003 Renal impairment 56.8% 0.025 Coagulopathy 41% <0.001

scholarly journals Use of carbapenems and glycopeptides increases risk for Clostridioides difficile infections in acute myeloid leukemia patients undergoing intensive induction chemotherapy

2020 ◽  
Vol 99 (11) ◽  
pp. 2547-2553
Author(s):  
Olivier Ballo ◽  
Eva-Maria Kreisel ◽  
Fagr Eladly ◽  
Uta Brunnberg ◽  
Jan Stratmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Bacterial Infections ◽  
Treatment Strategies ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Clostridioides Difficile ◽  
Acute Myeloid

Abstract Patients with acute myeloid leukemia (AML) are often exposed to broad-spectrum antibiotics and thus at high risk of Clostridioides difficile infections (CDI). As bacterial infections are a common cause for treatment-related mortality in these patients, we conducted a retrospective study to analyze the incidence of CDI and to evaluate risk factors for CDI in a large uniformly treated AML cohort. A total of 415 AML patients undergoing intensive induction chemotherapy between 2007 and 2019 were included in this retrospective analysis. Patients presenting with diarrhea and positive stool testing for toxin-producing Clostridioides difficile were defined to have CDI. CDI was diagnosed in 37 (8.9%) of 415 AML patients with decreasing CDI rates between 2013 and 2019 versus 2007 to 2012. Days with fever, exposition to carbapenems, and glycopeptides were significantly associated with CDI in AML patients. Clinical endpoints such as length of hospital stay, admission to ICU, response rates, and survival were not adversely affected. We identified febrile episodes and exposition to carbapenems and glycopeptides as risk factors for CDI in AML patients undergoing induction chemotherapy, thereby highlighting the importance of interdisciplinary antibiotic stewardship programs guiding treatment strategies in AML patients with infectious complications to carefully balance risks and benefits of anti-infective agents.

Patterns of Infection in Patients with Myeloid Malignancies Receiving 5-Azacytidine: identification of Candidates for Antifungal Prophylaxis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4955-4955
Author(s):  
Cristina Calderón ◽  
Jose F Falantes ◽  
Francisco Márquez-Malaver ◽  
Jose González ◽  
Maria Luz Martino ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Myelodysplastic Syndrome ◽  
Fungal Infection ◽  
Myeloid Leukemia ◽  
Hospital Admissions ◽  
Conflicts Of Interest ◽  
Infectious Complications ◽  
Febrile Episodes ◽  
Acute Myeloid

Abstract Abstract 4955 Introduction Infectious complications are among the most recurrent causes of mortality in patients (pts) with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) undergoing intensive chemotherapy (IC). These pts routinely receive anti-infective prophylaxis (AIP) with flourquinolones and antifungals. 5-azacytidine has recently been incorporated to treatment options for AML and MDS. However, the evidence of the effectiveness of AIP in patients treated with 5 azacytidine (AZA) is limited [1–3]. Objectives To analyze the incidence of episodes of infectious fever (IF), type of microbiological isolation and clinical relevance of infectious complications in AML and MDS pts treated with AZA who did not received prophylaxis. Identification a subgroup of pts who may benefit from AIP in this setting. Material/methods We retrospectively analyzed 48 pts with AML and MDS who received AZA from 2008, with a total of 365 cycles administered. Median age was 68 years (29–83y). Distribution: LMA (n=17) and MDS (n=31). One third of these pts had an absolute neutrophil count (ANC)<0. 5×10e9/L at time of starting AZA. Another 33% of pts had received prior IC, being all refractory to previous treatment. Baseline characteristics in table 1. Results Forty-eight febrile episodes were recorded (13% of IF/cycles of AZA). There was no difference in IF in pts with ANC<0. 5×109/L vs ANC>0. 5×10e9/L (p=0. 53). A total of 17 pts suffered at least one episode of IF (35% of the pts). Hospital admission was required in 14 of these 17 pts with a median time of hospitalization of 14 days (4–80). Mortality attributed to infectious complications ocurred only in 3/48 pts (6%). Twelve microbiological isolations were documented, the most common being: Gram negative bacilli (E Coli=4) and aspergillus reported as probable (n=4) and shown in table 1. Upon comparing pts who received prior IC (n=16; 33%) vs AZA as first line treatment, a higher risk for IF per cycle was observed in first group (18% vs 11. 5%; p=0. 06). Double of these pts developed fever (56% vs 25%; p=0. 03), required more hospital admissions (44% vs 22%; p=0. 21) and had longer duration of hospital stay (22 vs 14 days; p=0. 71). Finally, the group of patients that underwent previous IC, had higher rate of fungal infection by aspergillus and candida (5/9 isolations; 55% vs 0/5; 0%. P <0. 001), although no difference was observed in terms of mortality attributed to infection (6% each group) because of the reduced number of pts who died of this complication overall (3/48). Conclusions To our knowledge, this is the first study to evaluate the frequency and impact of IF in pts treated with AZA not receiving routinely AIP. Overall, the incidence of IF is lower than the reported in similar series. These results allow to identify pts that previously were treated with IC as those at highest risk of fungal infection. Thus, prophylaxis should be considered in this group. Prospective studies are needed to assess the requierement of prophylaxis during treatment with 5 azacytidine. Jain N et al. Benefit of Anti-infectious Prophylaxis in Patients with Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome receiving Frontline “Targeted Therapy”. Blood (ASH) 2007, 110:Abstract 2858 Je-Hwan Lee et al. Decreased incidence of febrile episodes with antibiotic prophylaxis in the treatment of decitabine for myelodysplastic syndrome. Leuk Res 35 (2011):499–503 Merkel D et al. Predictive Parameters for Infections During Azacitidine Therapy in High Risk MDS Patients. Blood (ASH) 2011, 118:Abstract 3811 Disclosures: No relevant conflicts of interest to declare.

Risk Factors for Infectious Complications in Adults with Acute Myeloid Leukemia Undergoing Induction Chemotherapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4043-4043
Author(s):  
Patrick Bruck ◽  
Thomas Parnavas ◽  
Dieter Hoelzer ◽  
Hubert Serve ◽  
Oliver G. Ottmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Retrospective Analysis ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Infectious Complications ◽  
Severe Neutropenia ◽  
Concomitant Treatment ◽  
Response To Chemotherapy ◽  
Acute Myeloid

Abstract Introduction: Febrile neutropenia is a common and potentially fatal consequence of Acute Myeloid Leukemia (AML). We performed a retrospective analysis of 97 adult AML patients (median age 67.6 y (58–78) treated between February 2000 and June 2005. Aim of the study was to evaluate risk factors for infectious complications and to identify underlying causative pathogens during first and second cycle of intensive induction chemotherapy. For statistical evaluation of the results, Students t-test, Fisher’ exact test or Chi square test were performed as appropriate. Results: Of the 97 episodes 64% occurred in male patients at a median age of 67.6 years (58–78). Patients developed fever not related to cytotoxic therapy or transfusion in 77 (80%) and no fever in 20 (20%) of the episodes. Compared to patients without infectious complications patients with fever had significantly more pretreatment comorbidities (0.80±1.20 vs 1.81±1.41, p=0.0042), a prolonged period of severe neutropenia (&lt;100/μl) (3.3±4.8 vs 13.6±8.4 days, p&lt;0.0001) and neutropenia &lt; 500/μl (5.6±7.2 vs 19.9±12.5 days, p&lt;0.0001). More patients in the fever group had a central venous catheter (15% vs 47%, p=0.02, OR 5.0, CI 1.35–18,38). Clinically, this group presented more grade III/IV symptoms like mucositis (30% vs 66%, p=0.007, OR 4.6, CI 1.58–13.3), nausea (10% vs 66%, p&lt;0.0001, OR 17.65, CI 3.8–81.97), vomiting (5% vs 49%, p=0.0008, OR 18.5, CI 5.38–19.86), diarrhea (15% vs 48%, p=0.01, OR 5.4, CI 1.46–19.9), any other gastroenterologic symptoms (5% vs 31%, p=0.03, OR 8.6, CI 1.1–68.9) and skin affections (40% vs 78%, p=0.002, OR 5.3, CI 1.86–15.0). Consequently, these patients were treated more often with interventionally intended G-CSF (15% vs. 26%, p=0.009, OR 11.7, CI 2.1–65.5) and received a higher number of antibiotic (p&lt;0.0001) and antimycotic regimens (p&lt;0.0001). Altogether twelve patients died within 39.9±31.1 days after the start of induction therapy. Of these, 10 deaths occurred in the fever group) with a clearly increased risk of septic reasons (p=0.04). We furthermore analyzed the effects of concomitant medication on the occurrence and outcome of febrile episodes. No difference was noted for the concomitant treatment as gastric acid suppression (p=0.43), antihistaminics (p=0.45) or corticosteroids (p=0.24) for all patients with fever. In the subgroup with proven bacterial infection the use of steroids was significantly different (p=0.009) and a trend for the use of antihistaminics was found (p=0.06). In the subgroup with an at least probable fungal infection or dead patients the use of steroids was significant (p=0.001 resp. p=0.03). No differences were noted between the first and second cycle of induction or the response to chemotherapy. Conclusion: Our data support the importance of preexisting features as the presence and number of comorbidities that have a profound impact on the risk of infectious complications during induction chemotherapy in AML while response to chemotherapy does not seem to have an impact in our relatively small cohort. Furthermore, the clinically necessary concomitant medications seem to play a role only in subgroups. As this is a retrospective analysis, confounding influences e.g. as antipyretic medication cannot be excluded. As the outcome of patients was generally not statistically different we recommend treating patients at risk prophylactically with broader spectrum antibiotics and a close clinical and laboratory monitoring.

Second Bacteremia During Antibiotic Treatment In Children With Acute Myeloid Leukemia: A Report From The Canadian Infections In AML Research Group

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1415-1415
Author(s):  
Thai Hoa Tran ◽  
Rochelle Yanofsky ◽  
Donna Johnston ◽  
David Dix ◽  
Biljana Gillmeister ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Antibiotic Treatment ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Gram Positive ◽  
Hematopoietic Stem ◽  
Gram Negative ◽  
Acute Myeloid

Abstract Background The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). Methods We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. Results There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.07-1.12; P<0.0001), cumulative dose of corticosteroids (OR 1.04, 95% CI 1.00-1.08; P=0.035) and days of neutropenia from start of course to initial bacteremia (OR 1.07, 95% CI 1.02-1.12; P=0.007) were significantly associated with second bacteremia. Conclusion In pediatric AML, 6% will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia. Abbreviations CONS: coagulase negative Staphylococcus ; VGS: viridans group Streptococcus; Amp: ampicillin; Cz: ceftazidime; Cef: cefotaxime; Cipro: ciprofloxacin; Clin: clindamycin; Clox: cloxacillin; G: gentamicin; Metro: metronidazole; Mero: meropenem; O: oxacillin; Pip: piperacillin; Ta: piperacillin/tazobactam; Tm:ticarcillin/clavulanate; To: tobramycin; V: vancomycin. Disclosures: No relevant conflicts of interest to declare.

Clostridium Difficile Infection in Patients with Acute Myeloid Leukemia

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5181-5181
Author(s):  
Amy L Morris ◽  
Mohammed Athar Naeem ◽  
Anjali Bal ◽  
Tanya Thomas ◽  
Alfadel Alshaibani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Clostridium Difficile ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Toxic Megacolon ◽  
Hematologic Malignancies ◽  
P Value ◽  
Disease Characteristics ◽  
Acute Myeloid

Abstract BACKGROUND: Clostridium difficile infection (CDI) is the most important cause of nosocomial infectious diarrhea and has been not well studied in patients with neutropenia who have hematologic malignancies in the United States. Previous studies suggest patients undergoing induction chemotherapy for acute myeloid leukemia (AML) are at a high risk of contracting CDI, but these patient's clinical and disease characteristics are not described. This study reports CDI rates and disease characteristics in AML patients at the University of Virginia (UVA). METHODS: A retrospective chart review of 126 consecutive patients undergoing induction or re-induction chemotherapy for AML at UVA from July 2011 to December 2015 was conducted. The primary endpoint was to determine the rate of CDI within ninety days of chemotherapy initiation. CDI was defined by a Clostridium difficile positive PCR in the presence of diarrhea. Secondary endpoints include patient characteristics, comorbidities, risk factors, and disease specific indices associated with CDI. Statistical methods include nonparametric Wilcoxon test, Fisher's exact test, and Holm's sequential Bonferroni procedure as appropriate. Statistical significance was defined as p-value <0.05. RESULTS: Of 126 patients, 31 patients (24.6%) with AML had CDI. 8 patients (25.8%) had one recurrent episode of CDI, 2 patients (6.4%) had two recurrences, and 2 patients (6.4%) had more than two recurrences. 25 patients (80.6%) underwent CT abdominal imaging specifically for the CDI episode, revealing 2 patients (8%) with typhilitis. 2 patients (6.4%) developed toxic megacolon, but no patients underwent colectomy. There was no CDI specific mortality in these 31 patients. During the same 4 year timespan, an additional 27 patients with hematologic malignancies other than AML were identified. These two cohorts (AML and non-AML CDI patients) were not statistically different in terms of patient demographics (age, gender, BMI), medical comorbidities (tobacco use, asthma, COPD, cardiac disorders, CKD, and rheumatologic conditions), and CDI characteristics (recurrences, prior antibiotics prophylactic and treatment regimens, PPI medication usage, CDI treatment regimen and treatment duration, development of typhilitis and toxic megacolon, and mortality). The only statistically significant difference is the presence and increased duration of neutropenia in the AML CDI patient cohort (p-value < 0.001). DISCUSSION: The study concludes that the incidence of CDI in patients with AML undergoing induction chemotherapy is greater than hospitalized patients without AML as reported in the literature. However, when compared to a matched cohort of hospitalized patients with non-AML hematologic malignancies, the incidence of CDI is similar between these two groups. This result is striking as AML induction chemotherapy regimens are typically more intense, resulting in more profound and longer neutropenia. Even with increased cytopenias, the CDI rate and disease characteristics are not affected when AML CDI patients are compared to non-AML CDI patients. This suggests that cytopenias should not be the focus for CDI patients, rather hematologic malignancies as whole lead to increased CDIs and heightened awareness is warranted when caring for patients with hematologic malignancies and complaints of diarrhea. Patients in both AML and non-AML CDI cohorts have relatively favorable outcome, with no patient mortality attributable to CDI. Further studies are needed to evaluate what, if any, predictive risk factors can increase CDI in the setting of AML. Disclosures No relevant conflicts of interest to declare.

Clostridium difficile infection in acute myeloid leukemia patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18503-e18503
Author(s):  
Anjali Bal ◽  
Amy Morris ◽  
Mohammed Athar Naeem ◽  
Tanya Thomas ◽  
Michael Kenneth Keng
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Myeloid Leukemia ◽  
Single Agent ◽  
P Value ◽  
Poor Risk ◽  
Disease Characteristics ◽  
Acute Myeloid

e18503 Background: Clostridium difficile infection (CDI) is the most important cause of nosocomial infectious diarrhea. Studies suggest patients (pts) undergoing acute myeloid leukemia (AML) chemotherapy (ctx) are at high risk of contracting CDI, but clinical and disease characteristics are not described. This study reports CDI rates and disease characteristics in AML pts at University of Virginia (UVA). Methods: A retrospective review of consecutive pt-encounters undergoing AML ctx at UVA from 2011-2016 was conducted. The main endpoint was to determine the rate of CDI within 90 days of ctx initiation, while assessing pt characteristics, comorbidities, risk factors, and disease specific indices associated with CDI. Statistical methods include nonparametric Wilcoxon and Fisher’s exact tests, with significance defined as p-value < 0.05. Results: Of 142 pts, 44 (31%) AML pts had CDI. 7 pts (15.9%) had 1 recurrent CDI episode,;2 pts (4.5%) had more than one. 18 pts (40.9%) underwent CT imaging specifically for CDI, revealing 3 pts (6.8%) with typhilitis and 2 pts (4.5%) with toxic megacolon requiring colectomy. There was no CDI associated mortality. At CDI diagnosis, 33 pts (75%) were neutropenic and 14 pts (31.8%) received prophylactic antibiotics. Median time from ctx was 12 days. Treatment for CDI: 38 pts (86.4%) single agent metronidazole or vancomycin and 6 pts (13.6%) combination. Sixteen (36.3%) CDI pts achieved CR, while 18 (40.9%) pts relapsed from AML. Compared to non-CDI pts, CDI pts were younger (50 v 59), less obese (BMI 26 v 29), poor-risk cytogenetics (26.5% v 14.1%), CKD (6.8% v 0.7%), prior cancer (6.8% v 2.8%). No statistical difference was seen in demographics (gender, race), comorbidities (tobacco use, pulmonary and cardiac disorders), or AML characteristics (bone marrow cellularity and blast, length of stay). Conclusions: The study concludes that the incidence of CDI in AML pts undergoing ctx is greater than hospitalized patients with or without malignancy as reported in the literature. CDI incidence is increased in younger, less obese, history of CKD or cancer, and poor-risk cytogenetics, suggesting potential predictive risk factors for CDI in AML pts. Further prospective studies are needed to confirm these potential CDI risk factors.

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