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Infections in patients with aplastic Anemia in Chiang Mai University
Rapee Lertpongpiroon1, Ekarat Rattarittamrong1, Thanawat Rattanathammethee1
1Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand.
Background:
Infection is a major complication in aplastic anemia (AA) patients. Primary objectives of this study were to determine the prevalence of infections and to determine types of pathogens associated with infections in patients with AA. Secondary objectives were to evaluate overall survival after infections as well as risk factors of infections in patients with AA.
Methods:
The authors retrospectively evaluated the infectious episodes (IEs), type of infections, associated pathogens, and outcomes of infections in patients with AA who were diagnosed and treated at Chiang Mai University between January 2010 and December 2015.
Results:
Sixty-seven patients with a median age of 51 years (range, 15-87 years) were enrolled. Forty two patients (62.6%) were severe AA. Median absolute neutrophil count (ANC) was 984 /mm3 (range, 120-5500/mm3). Twenty five patients (37.3%) received antithymocyte globulin plus cyclosporine A, 41 patients (61.1%) received anabolic hormone, and 2 patients (2.9%) underwent allogeneic hematopoietic stem cell transplantation. Overall, 31 IEs were documented in 22 patients (32.8%). The most common microbiologically documented site of infection was bloodstream infection (23.4%) followed by pulmonary infection (14.9%). Culture-negative febrile neutropenia occurred in 12.7%. Common pathogens identified were bacteria (73.9%), mainly gram-negative (52.9%) including Acinetobacter baumannii (23.5%) and Pseudomonas aeruginosa (17.6%). Fungal infections were diagnosed in 21.7% and all were Aspergillus spp. Six patients (9%) died during the study period. All of them died from infection which gram-negative bacteria were most common pathogens (66.7%). Patients with infections had 5-year overall survival of 72% that is significantly less than patients without infection (100%) (p = 0.0002). Only risk factor that correlates with high probability of infection was ANC < 500/mm3. (HR 2.29, 95%CI 1.03-7.72, p = 0.043).
Conclusions:
Prevalence of infections in AA patients in Chiang Mai University was 32.8% Bacterial infections especially gram-negative bacteria were the major pathogens. Patients with ANC < 500/mm3 had higher risk of infections. Infection was the most important cause of death in AA.
Insights
Infections complicate aplastic anemia (AA) care, with gram-negative bacteria being common pathogens. Low absolute neutrophil count (ANC) increases infection risk, and infection is a leading cause of death in AA patients.
Area of Science:
- Hematology
- Infectious Diseases
- Aplastic Anemia Research
Background:
- Infection is a significant complication for patients with aplastic anemia (AA).
- Understanding infection prevalence, pathogens, and risk factors is crucial for managing AA patients.
Purpose of the Study:
- To determine the prevalence and types of infections in AA patients.
- To identify pathogens associated with infections in AA.
- To evaluate survival outcomes and risk factors for infection in AA.
Main Methods:
- Retrospective evaluation of infectious episodes, pathogens, and outcomes in AA patients.
- Data collected from Chiang Mai University between January 2010 and December 2015.
- Analysis included patient demographics, treatments, infection sites, causative agents, and survival rates.
Main Results:
- 32.8% of AA patients experienced infections, with bloodstream and pulmonary infections being most common.
- Bacterial infections, particularly gram-negative bacteria like Acinetobacter baumannii and Pseudomonas aeruginosa, were predominant.
- Patients with an absolute neutrophil count (ANC) below 500/mm³ had a significantly higher risk of infection (HR 2.29).
Conclusions:
- Bacterial infections, especially gram-negative, are the primary cause of infections in AA patients.
- An ANC < 500/mm³ is a significant risk factor for developing infections in AA.
- Infection remains the leading cause of mortality in aplastic anemia.
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