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
{"title":"当代无氟喹诺酮类药物预防的AML诱导化疗期间感染","authors":"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","doi":"10.1007/s15010-025-02651-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Infections during AML induction chemotherapy in a contemporary cohort without fluoroquinolone prophylaxis.\",\"authors\":\"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\",\"doi\":\"10.1007/s15010-025-02651-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":13600,\"journal\":{\"name\":\"Infection\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s15010-025-02651-4\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s15010-025-02651-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Infections during AML induction chemotherapy in a contemporary cohort without fluoroquinolone prophylaxis.
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.
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.
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