Septicemia in Chemotherapy Induced Neutropenic Acute Myeloid Leukemia (AML) Inpatients and Outpatients: A 5 Year Retrospective Experience.
Notice bibliographique
Résumé
Abstract Patients (pts) with AML undergoing curative intent chemotherapy (CTX) are highly susceptible for septicemia due to profound and prolonged neutropenia, in conjunction with damage to the gastrointestinal mucosa, and the use of vascular access devices. Despite aggressive empiric antimicrobial therapy, and the use of prophylactic antibiotics, septicemia remains a major cause of morbidity in this group. Over the past decade the spectrum of pathogens that cause infections in neutropenic pts has changed, with gram+ve microorganisms replacing gram-ve bacilli. In order to identify the incidence, and cause of septicemia and the resistance pattern of bacteria in AML pts treated with curative intent CTX in the Leukemia/BMT program of BC, all positive blood cultures collected between Feb, 1999 and Feb, 2004 were evaluated retrospectively. 623 separate CTX cycles administered to 295 patients were reviewed (m=157, f=138). Median age at diagnosis was 52y (17–76). CTX regimen were classified as 7+3 or similar (conventional dose cytarabine + anthracycline) (group 1), or as high dose cytarabine containing regimen (with or without anthracycline) (group 2). 328 cycles were given as induction intend-CTX, while 295 where given as consolidation. 426 cycles were spend entirely as inpatients (IP) (from administration of CTX to ANC>0.5); 40 cycles were spend as early discharge (ED) (from CTX administration to discharge as outpatient prior to d+15 or ANC>0.5); 157 cycles were spend entirely as outpatients (OP). 126 episodes of septicemia were recorded in 623 cycles of CTX (20%), of which 21 episodes yielded more than 1 identified organism. Percent occurrence of septicemia stratified by CTX protocol indicated 17% (57/332) for group 1, and 24% (69/291) for group 2 (p<0.05). When stratified by CTX sequence, we note a difference in septicemia incidence between induction-intent CTX 17% (55/328), and consolidation CTX 24% (71/295) (p<0.05). Percent positive blood cultures per cycle discharge status were 25% for IP, 33% for ED, and 17% for OP (p<0.05). A total of 152 isolates were found, grouped as 53% gram +ve, 40% gram-ve, 3% unknown, and 4% fungal. The dominant organisms were coagulase negative Staphylococcus (22%), Viridans Streptococcus (18%), E.coli (11%), Klebsiella sp. (8%), and Staphylococcus aureus (4%). E.coli displayed resistance to ampicillin in 44%, and resistance to ciprofloxacin in 27% of isolates (all ciproRE.coli were also ampR). In addition 2 MRSA were isolated, and no vancomycin resistance was encountered in any isolates.142 pts died since diagnosis, while 153 are alive with a follow-up of 729d median (range 5d-1827d). The cause of death was relapse or refractory AML in 78% (110/142), treatment related mortality (TRM) post BMT in 13% (19/142), TRM post CTX in 7% (10/142). Of the 10 pts who died of post chemo TRM, only 1 died as a direct result of septicemia. Septicemia remains a frequent complication in high-risk neutropenic AML pts. Supported by our results, we have constructed an infectious risk stratification scheme pertaining to the CTX treatment of AML in IP, OP and ED settings. Furthermore, we report that while infections in this population constitutes a significant source of morbidity, mortality directly attibutable to septicemia is rare with prompt intervention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».