Analysis of the Infections in Patients with Adults Acute Myelogenous Leukemia

Kim, Sung Mok; Choi, Jae Hyuk; Lee, Sang Yeop; Kim, Byeong Duk; Lee, Kyung Hee; Hyun, Myung Soo

Abstract

BACKGROUND
Significant improvements in the treatment of acute myelogenous leukemia (AML) has been contributed by the development of remission induction and consolidation chemotherapy. But the infection is one of the most important and fatal complications in patients with AML. Therefore the effective treatment and preventive strategies of these infections are essential in order that more patients may achieve a complete remission and long-term disease free-survival. The purpose of this study was to determine the recent incidence of infections and to evaluate response for the empiric antibiotic treatment during chemotherapy.
METHODS
The records of 102 patients from a consecutive series of 206 admission episodes between April 1985 to December 1997 were reviewed retrospectively. When fever was developed, samples for microbiologic cultures and radiologic studies were done. Fine needle aspiration and/or biopsy from suspected lesions were done, if the studies mentioned above are unrevealing.
RESULTS
Febrile episodes were developed in 123 of 206 admission session. The microbiologically defined infection (MDI) and clinically defined infection (CDI) were developed in 51.2% and 37.4% of episodes, respectively. Fever was developed in 80.7%, 30.2%, and 77.8% in cases receiving remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy, respectively. The most frequent sites of infections were lung (27.8%) and blood (27.8%). Staphylococcus epidermidis was the most common causative organism of bacteremia. The initial antimicrobial therapy was not modified in 8 of 123 febrile episodes. The rate of overall response to antimicrobial therapy was 65%. The rate of overall response to antimicrobial therapy during remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy was 70.4%, 89.4%, 71.4%, respectively.
CONCLUSION
Infection has been a major cause of morbidity and mortality in acute myelogenous leukemia. Thus, intensive treatment needs for infection. More effective approaches should be evaluated by using more effective prophylactic and treatment modalities including new antimicrobials and by considering the changing spectrum of microbials.