Infectious Features In Patients with Acute Leukemia

Choi, Jung Hyun; Kim, You Joung; Lee, Dong Gun; Shin, Wan Shik; Kim, Sun Woo; Bae, Sang Soo; Kim, Se Hee; Yoo, Jin Hong; Kim, Kyung Mi; Han, Kyung Ja; Lee, Jong Wook; Min, Woo Sung; Kim, Chun Choo

Abstract

PURPOSE: Despite the advancement in chemotherapy and supportive care, a persisting problem in patients with leukemia is infectious complications, which are the leading cause of death. We evaluated infectious complications in acute leukemic patients to understand the current features and also evaluated risk factors for death in acute leukemia.
METHODS
The medical records of 186 cases of acute leukemia who underwent chemotherapy in St. Mary's Hospital between January 1995 and December 1997 were reviewed. And we compared these data to our previous data published in 1994.
RESULTS
One hundred (95%) cases among 126 leu- kemic patients who received induction chemotherapy and 42 (70%) of 60 cases who received consolidation chemotherapy experienced at least one febrile episodes during treatment. Microbiologically defined infection (MDI), clinically defined infection (CDI), and unexplained fever (UF) were evenly distributed. In MDI, the isolation rate of gram positive organism was markedly increased but that of fungus was decreased. The common clinical manifestations were bacteremia, pneumonia, neutropenic enterocolitis, and catheter infection, in the order of decreasing frequency. The overall mortality rates reduced from 50% (early of the 1980s) to 12.9%, but the infection-related mortality increased up to 80% in spite of improvement in supportive care, antimicrobials and administration of hematopoietic growth factors. Refractory or relapsed acute myelogenous leukemia (AML) had 5 times higher risk of death than primarily diagnosed AML and MDI had 10.9 times higher risk of death than UF. And one more febrile day increased the risk of death by 1.4 times.
CONCLUSION
Infection is still the most important cause of morbidity and mortality in acute leukemia patients. Dominant infecting organisms are changing from gram-negative bacilli to gram-positive cocci. New preventive, diagnostic, and treatment strategies should be developed and prophylactic use of antimicrobials should be restricted as much as possible to prevent emergence of resistant microorganisms.