Colonization with multidrug resistant organisms determines the clinical course of patients with acute myeloid leukemia undergoing intensive induction chemotherapy

Introduction: The global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodefic
Introduction: The global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodeficiency are especially at risk for fatal infections caused by MDRO. The impact of MDRO colonization on the clinical course of AML patients undergoing intensive induction chemotherapy—a potentially curative but highly toxic treatment option—has not been systematically studied.
Materials & methods: 312 AML patients undergoing intensive induction chemotherapy between 2007 and 2015 were examined for MDRO colonization. Patients with evidence for MDRO before or during the hospital stay of induction chemotherapy were defined as colonized, patients who never had a positive swab for MDRO were defined as noncolonized.
Results: Of 312 AML patients 90 were colonized and 130 were noncolonized. Colonized patients suffered from significantly more days with fever, spent more days on the intensive care unit and had a higher median C-reactive protein value during the hospital stay. These findings did not result in a prolonged length of hospital stay or an increased mortality rate for colonized patients. However, in a subgroup analysis, patients colonized with carbapenem-resistant enterobacteriaceae (CRE) had a significantly reduced 60- and 90-day, as well as 1- and 2-year survival rates when compared to noncolonized patients.
Conclusion: Our analysis highlights the importance of intensive MDRO screening especially in patients with febrile neutropenia since persisting fever can be a sign of MDRO-colonization. CRE-colonized patients require special surveillance, since they seem to be at risk for death.
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Metadaten
Author:Olivier Karl Friedrich Ballo, Ikram Tarazzit, Jan Stratmann, Claudia Reinheimer, Michael Hogardt, Thomas Alexander Wichelhaus, Volkhard A. J. Kempf, Hubert Serve, Fabian Finkelmeier, Christian Hubertus Brandts
URN:urn:nbn:de:hebis:30:3-488403
DOI:http://dx.doi.org/10.1371/journal.pone.0210991
ISSN:1932-6203
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=30673776
Parent Title (English):PLoS one
Publisher:PLoS
Place of publication:Lawrence, Kan.
Contributor(s):Senthilnathan Palaniyandi
Document Type:Article
Language:English
Year of Completion:2019
Date of first Publication:2019/01/23
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2019/01/24
Tag:Acute myeloid leukemia; Chemotherapy; Death rates; Enterobacteriaceae; Fevers; Hospitals; Methicillin-resistant Staphylococcus aureus; Neutropenia
Volume:14
Issue:(1): e0210991
Pagenumber:12
First Page:1
Last Page:12
Note:
Copyright: © 2019 Ballo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
HeBIS PPN:446225444
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Open-Access-Publikationsfonds:Medizin
Licence (German):License LogoCreative Commons - Namensnennung 4.0

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