Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia.
BACKGROUND
Curative intent chemotherapy for acute myelogenous leukemia (AML) leads to prolonged severe neutropenia, during which patients are highly susceptible to infection. Traditionally these high-risk patients were treated as inpatients. Our center recently implemented a selective ambulatory management policy for AML patients undergoing chemotherapy.


METHODS
A retrospective analysis was conducted to assess the occurrence of septicemia in AML patients treated over a 5 years period with curative intent chemotherapy. This review encompasses a change in policy from primarily inpatient care to selective outpatient management coupled with prophylactic antibiotic therapy.


RESULTS
A total of 294 patients, receiving 623 cycles of chemotherapy were identified. A significant decrease in septicemia was observed from the inpatient to outpatient cohort (22% to 13% P < 0.05), which correlated with the shift towards outpatient treatment of consolidation cycles. A shift from Gram-negative to Gram-positive organisms as the cause of septicemia was also detected in the outpatient cohort, likely due to the introduction of ciprofloxacin prophylaxis. No significant emerging resistance and no septicemia-related mortality were noted in the outpatient cohort.


CONCLUSIONS
The observed decrease in the incidence of septicemia in the ambulatory cohort adds supportive evidence to the feasibility of selective outpatient management of AML patients with respect to infectious complications.
Halim
T Y
TY
Department of Immunology and Microbiology, University of British Columbia, Vancouver, Canada.
Song
K W
KW
Barnett
M J
MJ
Forrest
D L
DL
Hogge
D E
DE
Nantel
S H
SH
Nevill
T J
TJ
Shepherd
J D
JD
Smith
C A
CA
Sutherland
H J
HJ
Toze
C L
CL
Lavoie
J C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology