Nosocomial infections in acute leukemia: comparison between younger and elderly patients

The progressive decline in immune functions render elderly individuals more susceptible to infections than younger patients. To evaluate potential age-related differences in nosocomial infections between younger (<60 yr) and elderly (> or =60 yr) patients with acute leukemia, we retrospectively reviewed 161 consecutive febrile episodes. All neutropenic patients with an absolute neutrophil count (ANC) less than 500/microl were examined during the different phases of intensive chemotherapy and hospitalized until fever and neutropenia resolved. Fever was recorded in 66% of younger and in 64% of elderly patients and occurred respectively in 45% and in 51% during induction, in 32% and in 36% during consolidation, in 23% and in 13% during relapse/refractory treatment (P=0.01). A central venous catheter (CVC) was present in 68% and in 42% of patients (P=0.001). Febrile episodes during severe neutropenia with ANC <100/microl were recorded in 47% and in 22% respectively, during neutropenia with ANC >100/microl in 53% and in 78% respectively (P=0.002). No significant difference was documented in the overall incidence of infections, type of febrile episodes, nosocomial pattern, defervescence-time, median duration of antimicrobic therapy and in overall outcome. Elderly patients do not seem to be more susceptible to infections than younger ones, although the lower frequency of some risk factors must be taken into account.