Infections during AML induction chemotherapy in a contemporary cohort without fluoroquinolone prophylaxis.

IF 3.6 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-10-01 DOI:10.1007/s15010-025-02651-4

S Ehrlich, J Eufinger, N Tahiri, V Jurinovic, S Mansournia, W G Kunz, J Jung, T Herold, M Subklewe, V Bücklein, M von Bergwelt-Baildon, K Spiekermann

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引用次数: 0

Abstract

Purpose: Recent advances in the treatment of acute myeloid leukemia (AML) and optimized supportive care have improved survival outcomes. However, infections during remission induction chemotherapy remain a leading cause of morbidity and mortality. While antifungal prophylaxis is standard, the role of routine antibacterial prophylaxis is increasingly debated due to adverse effects and resistance. This study aimed to characterize infectious complications in a real-world AML cohort receiving induction chemotherapy without routine antibacterial prophylaxis.

Methods: We retrospectively analyzed 103 adults with newly diagnosed AML who underwent intensive induction therapy at LMU University Hospital between January 2019 and December 2022. All patients received antifungal prophylaxis whereas antibacterial fluoroquinolone (FQ) prophylaxis was not administered. We assessed febrile episodes, clinically and microbiologically documented infections, ICU/IMC admissions, and 30-/90-day mortality.

Results: Febrile episodes occurred in almost all patients. Clinically documented infections accounted for 29.8% and microbiologically confirmed infections for 22.9% of febrile events. Bacteraemia was evenly distributed between Gram-positive and Gram-negative pathogens; multidrug resistance was rare. Proven or probable invasive fungal infections occurred in 6.8% of patients. In 47.2% of cases, the cause of fever remained unknown. Infection-related 30-day mortality was 4.9%. Factors associated with increased 30-day mortality included age ≥ 65 years, ECOG ≥ 2, secondary AML, and ICU/IMC admission for infection.

Conclusion: Infections remain a major challenge during AML induction therapy. Our findings suggest that FQ prophylaxis should be reevaluated in this setting, focussing on a more individualized approach. In addition, novel diagnostic tools are urgently needed to enable earlier and more targeted infection management in this high-risk population.

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当代无氟喹诺酮类药物预防的AML诱导化疗期间感染

目的：急性髓性白血病（AML）治疗的最新进展和优化的支持治疗改善了生存结果。然而，缓解诱导化疗期间的感染仍然是发病率和死亡率的主要原因。虽然抗真菌预防是标准的，但由于不良反应和耐药性，常规抗菌预防的作用越来越受到争议。本研究旨在描述真实世界AML队列中接受诱导化疗而不进行常规抗菌预防的感染并发症。方法：我们回顾性分析了2019年1月至2022年12月期间在LMU大学医院接受强化诱导治疗的103例新诊断的AML成人患者。所有患者均接受抗真菌预防治疗，而未给予氟喹诺酮类抗菌药物预防治疗。我们评估了发热发作、临床和微生物学记录的感染、ICU/IMC入院情况和30 /90天死亡率。结果：几乎所有患者均出现发热发作。临床记录的感染占29.8%，微生物学证实的感染占22.9%的发热事件。菌血症在革兰氏阳性和革兰氏阴性病原菌中分布均匀；多药耐药罕见。确诊或可能的侵袭性真菌感染发生在6.8%的患者中。在47.2%的病例中，发热原因不明。感染相关的30天死亡率为4.9%。与30天死亡率增加相关的因素包括年龄≥65岁、ECOG≥2、继发性AML和因感染入院ICU/IMC。结论：感染仍然是AML诱导治疗的主要挑战。我们的研究结果表明，在这种情况下，应该重新评估FQ预防，重点放在更个性化的方法上。此外，迫切需要新的诊断工具，以便在这一高危人群中进行更早和更有针对性的感染管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.