Septicemia in Chemotherapy Induced Neutropenic Acute Myeloid Leukemia (AML) Inpatients and Outpatients: A 5 Year Retrospective Experience.
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".