Infection analysis in acute lymphoblastic leukemia: a report of 499 consecutive episodes in India.
The use of empirical antibiotic combinations in the treatment of febrile neutropenic patients has decreased complication-related mortality in cancer patients. We have analyzed retrospectively 499 consecutive episodes of fever in 432 patients with acute lymphoblastic leukemia over a 5-year period. We have compared various antibiotic combinations used empirically in our study. Of the febrile episodes, 92% were neutropenic. The most common site of clinical documentation was the lung. The most common pathogen isolated in our setting was Pseudomonas aeruginosa (27.27%). The overall response rate to first-line empirical antibiotic combination was seen in 61.92%, the best results being with ceftazidime and amikacin combination (65.69%). A uniform antibiotic policy resulted in a decrease in mortality, with the number of deaths decreasing significantly in the 1989 to 1991 era (P = 0.00000003). The other contributing factors were an improvement in the supportive care with a reduction in length of hospital stay during induction. Our fungal isolates demonstrated 11 patients with documented fungal infection with a positive outcome in 8 patients.
Raje
N S
NS
Department of Medical Oncology, Tata Memorial Hospital, Bombay, India.
Rao
S R
SR
Iyer
R S
RS
Kelkar
R S
RS
Pai
S K
SK
Nair
C N
CN
Kurkure
P A
PA
Magrath
I T
IT
Advani
S H
SH
D000900:Anti-Bacterial Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005334:Fever; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology; D009503:Neutropenia / Q000139:chemically induced / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents