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Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid

Olivier Ballo1,2, Ikram Tarazzit1, Jan Stratmann1

  • 1Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt/Main, Germany.

Plos One
|January 24, 2019
PubMed
Abstract

Insights

Multidrug-resistant organism (MDRO) colonization in acute myeloid leukemia (AML) patients undergoing chemotherapy leads to more fever and ICU days. Carbapenem-resistant Enterobacteriaceae (CRE) colonization significantly reduces survival rates.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Oncology

Background:

  • The global rise of multidrug-resistant organisms (MDRO) poses significant challenges in healthcare settings, particularly for immunocompromised patients.
  • Patients with acute myeloid leukemia (AML) undergoing intensive chemotherapy are highly susceptible to infections from MDROs.
  • The impact of MDRO colonization on the clinical outcomes of AML patients during induction chemotherapy remains understudied.

Purpose of the Study:

  • To investigate the prevalence of MDRO colonization in AML patients receiving intensive induction chemotherapy.
  • To assess the clinical impact of MDRO colonization on these patients, including fever, intensive care unit (ICU) stay, and C-reactive protein (CRP) levels.
  • To determine the effect of MDRO colonization on the survival rates of AML patients.

Main Methods:

  • A cohort of 312 AML patients undergoing intensive induction chemotherapy between 2007 and 2015 was analyzed.
  • Patients were screened for MDRO colonization before or during their hospital stay for chemotherapy.
  • Colonized patients were compared to non-colonized patients based on clinical data and survival outcomes.

Main Results:

  • Of the 312 AML patients, 90 were colonized with MDROs.
  • Colonized patients experienced significantly more days with fever, longer ICU stays, and higher median CRP values.
  • While overall survival was not affected, a subgroup of patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) showed significantly reduced 60-day, 90-day, 1-year, and 2-year survival rates.

Conclusions:

  • Intensive MDRO screening is crucial for AML patients, especially those with febrile neutropenia, as persistent fever may indicate colonization.
  • CRE-colonized AML patients require heightened surveillance due to their increased risk of mortality.
  • Early identification and management of MDRO colonization are essential for improving outcomes in AML patients undergoing intensive chemotherapy.

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