Infection in acute leukemia: an analysis of 433 episodes

Two hundred fifty-seven patients with acute leukemia were admitted into our hospital on 346 occasions. There were 433 episodes of infection, with an average of 1.25 episodes per hospitalization; 126 patients (49.0%) died. Infection was the major predisposing factor and cause of death. The incidence of infection increased significantly with prolonged duration of hospitalization, the degree of granulocytopenia, the degree of chemotherapeutic failure, and the use of glucocorticoids. Pulmonary infection (17.3%) was the most common type of infection. Septicemia (12.0%) was also common and was associated with high mortality (71.2%). Of 22 patients with perirectal abscess, 10 had septicemia. Gram-negative bacilli were responsible for 66.1% of laboratory-documented bacterial infections. For the treatment of infection, empiric use of an aminoglycoside combined with either an antipseudomonal penicillin or a cephalosporin at the first sign of infection was emphasized. Antibiotic administration should be continued for at least 7 days after the patient's temperature becomes normal.