Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial, and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. In this review, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.
Keywords: Bacteremia; Chemotherapy; Infectious disease; Leukemia; Sepsis; Stem cell transplantation.
Conflict of interest statement
Competing interests: The authors declare no conflict of Interest.
Third Generation Cephalosporin Resistant Enterobacteriaceae and Multidrug Resistant Gram-Negative Bacteria Causing Bacteremia in Febrile Neutropenia Adult Cancer Patients in Lebanon, Broad Spectrum Antibiotics Use as a Major Risk Factor, and Correlation With Poor PrognosisR Moghnieh et al. Front Cell Infect Microbiol 5, 11. PMID 25729741.Our findings have major implications for the management of febrile neutropenia, especially in breakthrough bacteremia and fever when patients are already on broadspectrum …
Colonisation With ESBL-producing and Carbapenemase-Producing Enterobacteriaceae, Vancomycin-Resistant Enterococci, and Meticillin-Resistant Staphylococcus Aureus in a Long-Term Care Facility Over One YearC Ludden et al. BMC Infect Dis 15, 168. PMID 25887288.Among LTCF residents, colonisation with ESBL-EC and MRSA was common. All ESBL-EC were H30-Rx ST131, consistent with clonal dissemination.
Emergence of Carbapenem Resistant Gram Negative and Vancomycin Resistant Gram Positive Organisms in Bacteremic Isolates of Febrile Neutropenic Patients: A Descriptive StudyS Irfan et al. BMC Infect Dis 8, 80. PMID 18541017.This rising trend of highly resistant organisms stresses the increasing importance of continuous surveillance system and stewardship of antibiotics as strategies in the o …
[Prevention and Treatment of Febrile Neutropenia]F Montemurro et al. Tumori 83 (2 Suppl), S15-9. PMID 9235724. - ReviewMany chemotherapy regimens are associated with variable periods of myelosuppression. In cancer patients, neutropenia (less than 500 neutrophils/microL) is the most import …
[Etiology of Bacterial Infections in Febrile Neutropenic Patients: The Role of the Laboratory in the Diagnosis]C Poyart et al. Presse Med 33 (7), 460-6. PMID 15105768. - ReviewEPIDEMIOLOGICAL EVOLUTION: Until the mid-eighties, infectious complications (pneumonia, septicemia) observed in neutropenic patients were, in 70% of cases, of bacterial o …