Infections in acute myeloid leukemia: an analysis of 382 febrile episodes

Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia (AML). We retrospectively analyzed 382 febrile episodes encountered during induction and consolidation chemotherapy to determine the potential etiology, microbiologic spectrum, response/resistance to antibiotics and outcome. Between May, 2001 and December, 2006, 95 patients with de novo non-M3 AML received remission induction chemotherapy followed by consolidation in those who achieved complete remission. Patients median age was 28 years, ranging from 2 to 61 years, 26 patients were ≤15 years of age. There were 57 males and 38 females. Febrile neutropenia was defined as per international guidelines. A total of 382 febrile episodes were recorded; neutropenic 347 (induction phase 172, consolidation phase 175) and non-neutropenic 35 (induction 16, consolidation 19). Clinical, microbiological and radiological evidence of infection could be identified in 64% of the febrile episodes (74% during induction, 52% during consolidation). Pulmonary infections were most common, both during induction and consolidation phase. Microbiologically gram-negative infections predominated. There were 60 possible/probable/definite episodes of fungal infection. Six cases of tuberculosis (pulmonary 5 and spine 1) and 3 cases of malaria (including one case of cerebral malaria) were also identified. Nineteen patients died (17 during induction, 2 during consolidation); 17 deaths were infection related, 12/17 possibly due to fungal infections. We suggest that evaluation of antibacterial resistance patterns in an institution must be done routinely in order to choose empiric antibiotics therapy. Careful selection of antibiotics and early institution of antifungal therapy besides considering alternative diagnosis peculiar to the region (e.g. tuberculosis, malaria) may help in reducing morbidity and mortality during AML therapy.