Infections in Patients with Acute Leukemia (1993~1996)

Kim, Hong Bin; Park, Sang Won; Kim, Ui Seok; Kim, Jin Wook; Shin, Dong Hyeon; Oh, Myoungdon; Park, Seonyang; Kim, Byung Kook; Choe, Kang Won

Abstract

BACKGROUND
Infection is one of the major complications in patients with hematologic malignancies. Clinical spectrums of infectious diseases are changing due to the recent progress in the conservative management. The objective of this study was to determine the patterns and trends of infections in patients with acute leukemia.
METHODS
The medical records for 253 adult patients with acute leukemia admitted at the Seoul National University Hospital from January 1993 to December 1996 were reviewed retrospectively.
RESULTS
Clinical data of 186 subjects were available. Four hundred and four febrile episodes developed in 161 (86.6%) patients. Median duration of neutropenia, defined as absolute neutrophil count (ANC)<500/, was 18 days and ANC on the 1st day of infection was 0 (0~73,360)/microliter. Fever resolved in a median duration of 4 (1~73) days. Clinically-defined infection, microbiologically-defined infection and unknown fever accounted for 44.3, 36.6 and 19.1%, respectively. Pneumonia occured in 19.0% (62/327), infection of oral cavity in 15.6%, and perianal infection in 13.8%. Of 164 bacterial isolates, 100 were gram-negative, 62 gram-positive, and 2 Mycobacterium tuberculosis. Escherichia coli (32 isolates) was the most common organism, followed by Klebsiella pneumonia (24), Staphylococcus aureus (21) and Pseudomonas aeruginosa (18). Ten fungi including 1 Pneumocystis carinii and 6 Candida species were isolated. Out of 404 cases, 33 patients (8.2%) expired despite aggressive treatment. Twenty-eight patients died of infectious complications, including 17 pneumonia and 4 primary bacteremia.
CONCLUSIONS
There was a tendency to a increased proportion of microbiologically-defined infection, a fall in the frequency of P. aeruginosa and treatment outcomes significantly improved.