Decrease in Mortality from Sepsis: Impact of the Multidisciplinary Program for the Hematologic Patient at Very High...

Area of Science:

• Infectious Diseases
• Hematology
• Critical Care Medicine

Background:

• Hematologic patients face a high risk of infections, particularly from multidrug-resistant organisms (MDROs).
• Sepsis and MDRO colonization pose significant threats to patient outcomes in this vulnerable population.

Purpose of the Study:

• To evaluate the effectiveness of a multidisciplinary program (HAR) in reducing MDRO infections and sepsis-related mortality.
• To assess the program's impact on specific MDROs like carbapenemase-producing Klebsiella pneumoniae and multidrug-resistant Pseudomonas aeruginosa.

Main Methods:

• Retrospective comparison of pre-HAR (2016-2018) and post-HAR (2018-2019) periods.
• Inclusion of 262 patients undergoing hematopoietic stem cell transplant (HSCT) or intensive chemotherapy for acute myeloid leukemia (CH-AML).
• Analysis of MDRO infection rates and sepsis-related mortality.

Main Results:

• MDRO infections occurred in 4.6% at 30 days and 6.1% at 90 days, exclusively during the pre-HAR period.
• Overall sepsis-related mortality was 6.5% (median follow-up 608 days).
• Sepsis-related mortality decreased from 8.7% in the pre-HAR period to 0% in the post-HAR period (p=0.014).

Conclusions:

• The HAR program, integrating preventive measures and judicious antibiotic use, effectively decreased sepsis-related mortality.
• A multidisciplinary approach is crucial for managing infections in very high-risk hematologic patients.
• The program demonstrated success in controlling MDRO infections and improving survival outcomes.