International Journal of Hematology

DOI: 10.1007/s12185-010-0746-y Pages: 66-73

Analysis of bacteremia/fungemia and pneumonia accompanying acute myelogenous leukemia from 1987 to 2001 in the Japan Adult Leukemia Study Group

1. Teikyo University School of Medicine, Mizonokuchi Hospital, Fourth Department of Internal Medicine

2. Teikyo University School of Medicine, Department of Internal Medicine

3. Yokohama City University Hospital, Department of Rheumatology/Hematology/Infectious Disease

4. Nihon University School of Medicine, Department of Hematology and Rheumatology, Division of Medicine

5. Kinki University School of Medicine, Division of Hematology, Department of Internal Medicine

6. Gunma University Graduate School of Medicine, Department of Medicine and Clinical Science

7. Shiga University of Medical Science, Department of Internal Medicine

8. St. Marianna University School of Medicine, Division of Hematology and Oncology, Department of Internal Medicine

9. Hamamatsu University School of Medicine, Department of Medicine III

10. Jichi Medical University, Division of Hematology, Saitama Medical Center

11. Saiseikai Maebashi Hospital, Leukemia Research Center

12. Kanazawa University Graduate School of Medical Science, Department of Hematology

13. Tokyo Metropolitan Komagome Hospital, Division of Hematology

14. Hamamatsu University School of Medicine, Oncology Center

15. Tokyo Metropolitan Ohtsuka Hospital, Division of Hematology

16. Aichi Shukutoku University

17. Nagoya University Graduate School of Medicine, Department of Hematology and Oncology

Correspondence to:
Minoru Yoshida
Tel: +81-44-8443543
Fax: +81-44-8443546
Email: myoshida@med.teikyo-u.ac.jp

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Abstract

We analyzed the incidence and prognosis of bacteremia/fungemia and pneumonia during remission induction therapy of a newly diagnosed acute myelogenous leukemia (AML) in the Japan Adult Leukemia Study Group treated with individual protocols of AML-87/-89 (1987–1991), AML-92 (1992–1995), AML-95 (1995–1997), and AML-97 (1997–2001). Bacteremia/fungemia was present in 251 of 2585 cases (9.7%); the causative microorganism was gram-positive bacteria (GPB) in 122 cases (49%), gram-negative bacteria (GNB) in 90 cases (36%), fungi (F) in 31 cases (12%), and polymicrobes (P) in 8 cases (3%). Particularly prevalent were Pseudomonas aeruginosa in 49 cases (20%), Staphylococcus epidermidis in 29 cases (12%), and Staphylococcus aureus in 25 cases (10%). With AML-87/-89, incidence of bacteremia/fungemia was 11.8% while it was 9.4% with AML-92, 8.7% with AML-95, and 9.2% with AML-97. The proportion of GPB, GNB, F, and P was 40, 41, 16, and 3% in AML-87/-89, 46, 40, 11, and 3% in AML-92, 48, 39, 11, and 2% in AML-95, and 59, 26, 11, and 4% in AML-97. The mortality rate by period was 26.5, 16.4, 14.0, and 6.8%, respectively. Pneumonia was found in 433 cases (16.8%); microbiological research covered 359 cases of AML-87/-89, AML-92, AML-97 and excluded AML-95 as there was no listing for the causative microorganism on questionnaires. Microbiologically documented pneumonia was found in 123 cases (34.3%), with GPB in 33 cases (27%), GNB in 28 cases (23%), F in 44 cases (36%), and P in 18 cases (15%); particularly prevalent were Aspergillus in 23 cases (19%), Staphylococcus aureus in 16 cases (13%), and Pseudomonas aeruginosa in 15 cases (12%). The incidence of pneumonia overall was 24.6% with AML-87/-89, 16.9% with AML-92, 13.9% with AML-95, and 12.9% with AML-97, with a mortality rate of 28.9, 33.3, 16.7, and 16.7%, respectively. Incidence of bacteremia/fungemia and pneumonia complicating AML has tended to decline in recent years, and mortality has also tended to improve.

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