Infectious Complications in Adult Leukemic Patients with Prolonged Neutropenia Undergoing Induction Chemotherapy

Background: Induction chemotherapy in patients with the diagnosis of acute leukemia is associated with a high incidence of infectious complications. While prior studies provide information regarding infectious complications in this patient population, more research is needed to evaluate infection complications in a subgroup of leukemic patients with prolonged neutropenia who often require repeat induction chemotherapy. Methods: This was a retrospective analysis of 61 patients ages 18–85, between January 1, 2010 and March 14, 2018 who were diagnosed and being treated for acute leukemia. All selected patients experienced severe neutropenia (defined as absolute neutrophil count \u3c500/μL) for ≥7 days. 33 patients underwent their first induction chemotherapy while 28 patients underwent repeat induction chemotherapy. Patient characteristics and infectious complications were examined. Analysis was performed to further study blood stream infections in this patient population. Results: Sixty-one patients, mean age of 55 ± 17, were included in this study. Acute myelogenous leukemia was the most common diagnosis (n = 47, 77%). The average duration of neutropenia in single vs multiple induction group was 40 vs. 47.2 days (P = 0.38), respectively. 198 culture-proven infections were identified. Overall, bloodstream infections were the most common site (n = 78, 39.4%), followed by respiratory tract infections (n = 39, 19.7%). Gram-positive organisms were the leading etiology of bacteremias (n = 50, 64%). Bacteremia episodes were more common in the patients undergoing multiple induction chemotherapy comparing to a single treatment (45 vs. 33 episodes). Patients undergoing multiple induction chemotherapy experienced a higher rate of Gram-negative blood stream infection episodes comparing to a single induction group (n = 18/78, 23.1% vs. n = 10/78, 12.8%). Conclusion: Overall, bacteremia was the most common infection in this patient population, followed by respiratory tract infections. Gram-positive pathogens were the most common etiology of bacteremia when all patients were analyzed. However, in the subset of patients undergoing multiple induction chemotherapy, Gram-negative pathogens were the leading cause of the blood-stream infections