Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia

Abstract

Background: Patients with acute myeloid leukemia (AML) are at high risk for infections. The aim of this study was to identify the sources of fever and the type of pathogens that cause bloodstream infection in patients with AML undergoing cytotoxic chemotherapy and antibiotic prophylaxis.

Patients and methods: The source of fever and the type of pathogens causing bloodstream infection were identified for 129 febrile episodes experienced by 42 patients with AML receiving cytotoxic chemotherapy and antibiotic prophylaxis.

Results: A source of fever was identified in 81% of all febrile episodes. Mucositis (21.7%), pneumonia (13.2%), central venous catheter infection (12.4%), neutropenic enterocolitis (9.3%) and invasive fungal disease (9.3%) were the most common sources of fever. Of 16 central venous catheter infections, seven (43.8%) were not associated with local signs. 49 febrile episodes (37.9%) were associated with bloodstream infections, of which 14 (28.6%) were polymicrobic and seven (14.3%) had an undefined source of infection. Bloodstream infection was commonly associated with cellulitis (60%), mucositis (57.1%), central venous catheter infection (55.6%), neutropenic enterocolitis (41.7%) and invasive fungal disease (41.7%). Gram-positive microorganisms were the most common blood isolates (75.8%). Gram-negative bacteremic infections occurred in eight episodes (12.1%) experienced by patients who were not receiving ciprofloxacin prophylaxes at the time of bacteremia. Noninfectious sources of fever accounted for 23 (17.8%) of the 129 febrile episodes.

Conclusion: Although the spectrum of pathogens that cause infection in this group of patients has shifted from gram-negative to gram-positive bacteria, the most common sources of infection remain the same as previously described and they mainly involve integumental surfaces.