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Infections in hospitalized children and young adults with acute leukemia in Morocco
Jacqueline Depasse1, Miguela A Caniza, Asmaa Quessar
1Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA 94143-0106, USA.
Insights
Children and young adults with acute leukemia in Morocco experienced higher infectious mortality than in high-income countries. Improving infection care, diagnostics, and access to antibiotics is crucial for better leukemia survival.
Area of Science:
- Oncology
- Infectious Diseases
- Epidemiology
Background:
- Leukemia survival rates are lower in low- and middle-income countries compared to high-income nations.
- Febrile illness in leukemia patients presents a significant challenge, particularly in resource-limited settings.
- Understanding the epidemiology of febrile illness in pediatric and young adult leukemia is vital for improving outcomes.
Purpose of the Study:
- To describe the incidence, clinical features, and mortality of febrile illness in children and young adults with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
- To analyze data from two centers in Rabat and Casablanca, Morocco, during 2011.
- To identify factors contributing to mortality from febrile illness in leukemia patients.
Main Methods:
- A retrospective cohort study of patients under 30 years old newly diagnosed with AML or ALL in 2011.
- Chart review to collect data on demographics, febrile episodes, chemotherapy, and infection evidence.
- Analysis of clinical and microbiological data, including neutropenia, antibiotic use, and mortality.
Main Results:
- 166 patients experienced 228 inpatient febrile episodes; median episodes were 3 for AML and 1 for ALL.
- Common infections included pneumonitis and mucositis; Coagulase-negative staphylococcus was the most frequent isolate.
- Mortality rates per febrile illness were 11.3% for AML and 9.2% for ALL, with 53% of episodes classified as fever of undetermined origin.
Conclusions:
- Infectious deaths in Moroccan leukemia patients exceed those reported in high-income countries.
- Enhanced infection care, including prompt hospitalization, diagnostics, and antibiotics, is necessary.
- Standardizing patient care quality is essential to improve survival rates for leukemia patients in Morocco.
Background:
Overall survival from leukemia is less in low and middle-income countries than in high-income countries. Our purpose was to describe the incidence, clinical features, and mortality of febrile illness with or without documented infection in children and young adults treated for AML and ALL in two centers in Rabat and Casablanca during 2011.
Methods:
This retrospective cohort study included patients <30 years of age who were newly diagnosed with AML and ALL in 2011 in Casablanca and Rabat. Each patient's chart was evaluated for patient demographics, febrile episodes, chemotherapy regimen, and clinical or microbiological evidence of infection, neutropenia, antibiotics, and mortality.
Results:
One hundred sixty-six evaluable patients had 228 inpatient febrile episodes. The median number of febrile episodes in AML was three per patient, and for ALL, one per patient. Clinically identified infections mainly included pneumonitis and mucositis. Coagulase negative staphylococcus was the most commonly isolated bacterium, followed by gram-negative bacteria. Fifty-three percent of febrile episodes were classified as fever of undetermined origin. Broad-spectrum antibiotics were routinely used, with the addition of antifungals in 62 episodes and vancomycin in 83 episodes. The rate of deaths per febrile illness was 11.3% (16/141) in patients with AML, and 9.2% (8/87) in patients with ALL.
Conclusion:
The higher rate of infectious deaths in leukemia compared to that reported in high-income countries, suggests that improvements in infection care and prevention, including consistent access to rapid hospitalization, diagnostics and antibiotics; and standardizing quality of patient care are necessary to improve as well as survival in patients with leukemia in Morocco.
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