Infections in acute leukemia: a retrospective study of 148 patients

Abstract

To study the nature, offending organisms, consequence, and prognostic factors of infection in acute leukemia, we reviewed the cases of 148 patients admitted to the internal medicine service at Seoul National University Hospital between December 1980 and June 1984.

The findings are summarized as follows: (1) The total number of infections was 143, 54% of which occurred after anti-cancer chemotherapy (induction; 28%, maintenance; 14%, reinduction; 10%, consolidation; 2%). Fifty-one percent responded to therapy, and 24% expired due to infection (13%) or other causes (11%). (2) Sixty-four percent of the infections occurred during a granulocytopenic episode (>500/mm³), whereas 36% occurred in the absence of granulocytopenia. When induction, reinduction or consolidation chemotherapy was instituted, infection occurred in 85% of the cases in which granulocytopenia had developed (n=59) and in 50% of the cases in which granulocytopenia had not developed (n=14). (3) Microbiologically documented infection, clinically documented infection and, possible infection accounted for 19%, 47%, and 34% of the total infection episodes, respectively, and in microbiologically or clinically documented infection (n=95), mortality due to infection was 19%, compared to 2% in possible infection (n=48), which was significantly lower (P<.005). Gram negative and positive bacteria accounted for 71.4% and 25.0% of the microbiologically documented infection, respectively, and Pseudomonas species, E. coli, and Staphylococcus aureus were the most common pathogens. Pharyngitis was the most common type of infection to be followed by skin and soft tissue infection, pneumonia and primary septicemia, etc. (4) Eighty-eight and two tenths percent of the patients with bone marrow recovery responded to therapy, a percentage significantly higher than 46 5% for those whose bone marrow function was not restored (P<.005)