thioguanine-anhydrous and Sepsis

The purpose of this study was to assess the frequency of blood stream infections (BSIs) during neutropenia in different cycles of intensive chemotherapy treatment in acute myeloid leukemia (AML). The register data of 327 consecutive patients aged 16-66 years having de novo AML between September 1992 and December 2001 were prospectively gathered in five Finnish tertiary care leukemia centers. The patients had not received fluoroquinolone prophylaxis. Reported BSI rates were compared during neutropenia in four chemotherapy treatment cycles (C). There were 956 treatment episodes, with 456 (47.7%) positive blood cultures. BSI was monomicrobial in 327 episodes (71.7%) and polymicrobial in 129 (28.3%). The overall incidence rate (per 1,000 hospital days) for BSI was 13.2, varying from 6.8 in CI after idarubicin, conventional-dose cytarabine, and thioguanine to 15.6 in CII, 15.8 in CIII, and 17.6 in CIV. The distribution of monomicrobial gram-positive BSIs was as follows: CI, 71.7%; CII, 62.8%; CIII, 53.3%; CIV, 36.6%; and CI-IV together, 43.2%. The most common finding in the four different cycles was coagulase-negative staphylococci (38.3 to 30.6%). Viridans group streptococci were most commonly observed (in 20.4% of positive blood cultures) during CII after high-dose cytarabine and idarubicin treatments. The distribution of monomicrobial gram-negative BSIs was as follows: CI, 21.7%; CII, 36.3%; CIII, 45.7%; CIV, 46.9%; and CI-IV together, 37.9%. A great variation of incidence and types of microorganisms between AML chemotherapy cycles was found. It would be more reasonable to analyze chemotherapy cycle-based BSI results rather than the overall results.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Bacteria; Blood; Cytarabine; Female; Finland; Humans; Idarubicin; Incidence; Leukemia, Myeloid, Acute; Male; Middle Aged; Neutropenia; Prospective Studies; Sepsis; Thioguanine; Young Adult

The clinical courses of 54 consecutive adult patients with acute myelogenous leukemia (AML) who underwent 67 courses of intensive remission induction therapy were analyzed to assess factors associated with development of serious fungal and bacterial infections. Fever developed in 65 of 67 remission induction attempts and was due to bacterial, bacterial-fungal, and fungal etiologies in 49%, 14%, and 9% of cases, respectively. No etiology of fever was found in 28% of cases. Bacteremia occurred in 54% of remission induction attempts. Invasive fungal disease (IFD) occurred in 22% of cases with an overall mortality of 60%, including 45% of the patients who died during treatment. Using multivariate logistic regression analysis, a mathematical model was constructed which correlated with the risk of IFD. Major factors associated with patients who ultimately develop IFD included the duration of chemotherapy, the number of sites colonized with fungi and the number of fungal species isolated on certain surveillance cultures, particularly Aspergillus species. These studies define characteristics of patients at high risk for development of IFD for whom early initiation of empiric antifungal therapy is strongly recommended.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Risk; Sepsis; Statistics as Topic; Thioguanine

Topics: Aged; Alkaline Phosphatase; Anemia; Blood Transfusion; Bone Marrow; Busulfan; Cytarabine; Female; Histocytochemistry; Humans; Leukemia, Myeloid; Leukocytes; Male; Middle Aged; Pneumonia; Purpura; Radiography; Sepsis; Splenomegaly; Staphylococcal Infections; Tetracycline; Thioguanine

Topics: Aged; Anemia, Aplastic; Arsenic; Arsenic Poisoning; Autopsy; Biopsy; Bone Marrow Cells; Cytarabine; Environmental Exposure; Humans; Klebsiella Infections; Leukemia, Myeloid, Acute; Male; Oxymetholone; Penicillamine; Pesticides; Poisoning; Prednisone; Recurrence; Sepsis; Thioguanine