Impact of duration of antibiotic therapy on the prognosis of patients with acute myeloid leukemia who had Gram-negative bloodstream infection in consolidation chemotherapy.
10.3760/cma.j.issn.0253-2727.2018.06.006
- Author:
Run Xia GU
1
;
Hui WEI
;
Ying WANG
;
Bing Cheng LIU
;
Chun Lin ZHOU
;
Dong LIN
;
Kai Qi LIU
;
Shu Ning WEI
;
Ben Fa GONG
;
Guang Ji ZHANG
;
Yun Tao LIU
;
Xing Li ZHAO
;
Xiao Yuan GONG
;
Yan LI
;
Shao Wei QIU
;
Ying Chang MI
;
Jian Xiang WANG
Author Information
1. Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China.
- Publication Type:Journal Article
- Keywords:
Acute myeloid leukemia;
Bloodstream infection;
Duration of antibiotics therapy;
Infection associated death
- MeSH:
Anti-Bacterial Agents/therapeutic use*;
Antineoplastic Combined Chemotherapy Protocols;
Bacteremia/drug therapy*;
Consolidation Chemotherapy;
Humans;
Leukemia, Myeloid, Acute;
Prognosis;
Retrospective Studies
- From:
Chinese Journal of Hematology
2018;39(6):471-475
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. Methods: Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. Results: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×10(9)/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. Conclusion: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.
