Infectious complications of induction therapy in acute myeloid leukaemia patients without the use of antibiotic prophylaxis

Czech version

Authors: M. Čerňan ¹; T. Szotkowski ¹; M. Kolář ²; J. Hubáček ¹; E. Faber ¹
Authors‘ workplace: Hemato-onkologická klinika LF UP a FN Olomouc ¹; Ústav mikrobiologie LF UP a FN Olomouc ²
Published in: Transfuze Hematol. dnes,21, 2015, No. 1, p. 14-23.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

The induction chemotherapy represents one of the riskiest phases of therapy of acute myeloid leukaemia (AML) due to reduced haematopoiesis and a big tumour mass. Therefore, the infectious complications are very frequent in patients undergoing induction chemotherapy. They represent an important risk factor of the mortality of primary diagnosis. This research aims at describing the infectious complications and their therapy carried out during the first cycle of induction chemotherapy on the group of 100 AML patients, who were treated without antibiotic prophylaxis, in the Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc during the years 2007–2011. This research also compares the result of the above patient group with the groups of AML patients published in literature who had been given an antibiotic prophylaxis during induction. Our results showed that 93% of patients had infectious complications during induction chemotherapy. Clinically and/or microbiologically documented infections were described in 48 patients and febrile neutropenia was described in 45 patients. Sepsis was documented in 32 patients, inflammatory infiltrate of lungs and extrapulmonary infectious focuses were observed in 24 patients each. Proven invasive fungal infections were noticed in 2, probable in 4 and possible in 29 patients. The achieving of complete remission (67%) after induction therapy had a significant influence on lower occurrence of sepsis (22.4% vs. 51.5%, p = 0.0037), shorter hospitalization (35.1 vs. 39.4 days, p = 0.028), shorter antibiotic (27.8 vs. 35.0 days, p = 0.011) and antifungal (27.9 vs. 33.2 days, p = 0.031) therapy in comparison with non-remission patients. Seven patients undergoing induction chemotherapy had no signs of infection. Infectious complications were the cause of death in 3 patients. The results showed that, occurrence of infectious complications during induction was not significantly higher in patients without the use of antibiotic prophylaxis in comparison with published data of patients receiving antibiotic prophylaxis (93.0% vs. 85.2% (p = 0.088), respectively 91.3% (p = 0.58). The monitoring of bacterial resistance, adverse effects and clinical efficiency should be the conditions for using antibiotic prophylaxis in patients undergoing induction chemotherapy for AML.

Key words:
acute myeloid leukaemia, induction chemotherapy, infectious complications, complete remission

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