title: Infections in the immunocompromised host: a prospective multicenter survey in patients receiving chemotherapy for acute leukemia.
abstract: Patients receiving chemotherapy for acute leukemia were prospectively followed up to determine the frequency, nature and outcome, of episodes of infection during a 6 or 12 month period at each of the participating centres. A total of 605 cycles of chemotherapy were surveyed. Of these, 490 cycles were received by patients with acute lymphoblastic leukemia (ALL) and 115 by patients with acute non-lymphoblastic leukemia (ANLL). 241 episodes of infection were recorded during the survey: 179 among ALL patients and 62 among patients of ANLL. Infections were more common during chemotherapy for ANLL than for ALL, occurring in 54% (62/115) and 36% (179/490) of chemotherapeutic cycle respectively. A favorable response to empiric antibacterial agents was seen in 39% (23/59) of episodes in ANLL patients and 77% (134/174) of episodes among ALL patients. Infection presented as fever of unidentified origin in an overwhelming majority (63%) of episodes. Gastroenteritis and pneumonia occurred with a frequency of 11% and 10% while the frequency of all other diagnoses was 3% or less. Overall, E coli and Candida were the most frequently isolated organisms while Staphylococcus aureus and Group A Streptococci were the most frequent isolates from blood and throat swabs, respectively. A high degree of resistance to commonly used antimicrobial agents was seen among the most frequently isolated organisms. About 75% of episodes of infection which did not respond to antibacterial agents responded to empiric systemic antifungal therapy; although fungi were mycologically isolated in only a quarter of these instances. Oropharyngeal candidiasis occurred in association with 3% of chemotherapeutic cycles.
authors.affiliation: Dept of Medical Oncology, Tata Memorial Hospital, Mumbai.
authors.forename: S H
authors.initials: SH
authors.lastname: Advani
authors.forename: V
authors.initials: V
authors.lastname: Kochupillai
authors.forename: N
authors.initials: N
authors.lastname: Lalitha
authors.forename: V
authors.initials: V
authors.lastname: Shanta
authors.forename: V
authors.initials: V
authors.lastname: Maitreyan
authors.forename: R
authors.initials: R
authors.lastname: Nair
authors.forename: U
authors.initials: U
authors.lastname: Banerjee
authors.forename: R
authors.initials: R
authors.lastname: Kelkar
authors.forename: S
authors.initials: S
authors.lastname: Mukherjee
mesh_terms: D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000276:immunology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000276:immunology; D011446:Prospective Studies