Bloodstream infections in acute myeloid leukemia patients treated according to the Finnish Leukemia Group AML-2003
Aarne Kolonen1, Marjatta Sinisalo1, Reetta Huttunen1
1a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.
Background:
Infections greatly influence the outcome of acute myeloid leukemia (AML) patients receiving intensive treatment. The aim of this study was to establish the incidence, microbial etiology, risk factors and prognosis of bloodstream infections (BSIs) in patients with AML and compare the results with the previous treatment protocol (AML-92).
Methods:
Registery data were gathered prospectively from 357 patients aged 16-65 years recruited on the AML-2003 treatment protocol between November 2003 and November 2011 during different treatment cycles.
Results:
Blood culture data were available on 977 treatment episodes, in which there were 503 BSIs (51%). The overall incidence rate (IR) for BSIs (per 1000 hospital days) was 16.7. Twenty patients (5.6%) died due to an infection and 16 of them (80%) had a BSI. The most commonly detected microbes (polymicrobial episodes included) in blood cultures were coagulase-negative staphylococci (CoNS, 24.7%), viridans group streptococci (VGS, 19.1%), enterococci (13.9%) and Enterobacteriacae group (25.9%). The etiology of BSIs varied greatly from treatment cycle to cycle.
Conclusions:
Enterococcal BSIs have increased compared to our previous treatment protocol, and they represent significant pathogens in blood cultures. Infection-related mortality has decreased despite the increase in the IR of BSIs. Enterococci seem to be an increasingly prominent pathogen underlying BSIs in the AML patients, especially during induction therapy (20%).
Insights
Bloodstream infections (BSIs) are common in acute myeloid leukemia (AML) patients. While infection rates increased, infection-related deaths decreased, with enterococci emerging as a significant pathogen.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Microbiology
Background:
- Infections significantly impact treatment outcomes for acute myeloid leukemia (AML) patients undergoing intensive therapy.
- Understanding bloodstream infections (BSIs) is crucial for managing AML patient prognosis.
Purpose of the Study:
- To determine the incidence, microbial causes, risk factors, and prognosis of BSIs in AML patients.
- To compare BSI data from the AML-2003 protocol with the previous AML-92 protocol.
Main Methods:
- Prospective data collection from 357 AML patients (aged 16-65) on the AML-2003 protocol (Nov 2003 - Nov 2011).
- Analysis of 977 treatment episodes with available blood culture data.
Main Results:
- 503 BSIs (51%) occurred across 977 treatment episodes, with an overall incidence rate of 16.7 BSIs per 1000 hospital days.
- Coagulase-negative staphylococci (24.7%), Enterobacteriaceae (25.9%), viridans group streptococci (19.1%), and enterococci (13.9%) were the most frequent microbes.
- Infection-related mortality was 5.6%, with 80% of these deaths linked to BSIs.
Conclusions:
- Enterococcal BSIs have increased compared to the AML-92 protocol, posing a significant threat.
- Despite rising BSI incidence, infection-related mortality has decreased.
- Enterococci are an increasingly prominent cause of BSIs in AML patients, particularly during induction therapy (20%).
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