Healthcare-associated infections among patients with different types of acute leukemia in China: A surveillance-based study

Abstract

Healthcare-associated infections (HAIs) may be diverse among patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). However studies were limited. We aimed to quantify and compare the characteristics and relevant factors associated with HAIs among patients with AML and ALL. The surveillance-based study was conducted in a university teaching hospital. All adult patients diagnosed with acute leukemia (AL) and admitted into the Hematology Department for over 48 h were included. HAI characteristics and relevant factors were compared between AML and ALL patients. A consecutive sample of 994 patients with AL was recruited. The proportions of infected cases (27.78% <em>vs</em>. 28.31%, <em>p</em> = 0.888) and the HAI incidence (21.29 <em>vs</em>. 22.82 per 1,000 patient-days at risk, <em>p</em> = 0.733) were comparable among AML and ALL patients, respectively. Compared with ALL patients, higher risks of HAIs were found among AML patients with increasing duration of chemotherapy or lower hemoglobin level. Meanwhile, increased length of stays during previous cycles of chemotherapy, lower level of platelets, and diabetes were associated with higher risks of HAIs among ALL patients compared with AML patients. In conclusion, our results found that AML and ALL patients experienced different risks of HAIs associated with diverse relevant factors. Future multi-center studies are needed to provide stronger evidence.

Prospective surveillance of hospital associated infections epidemiology in a haematology-oncology department

“…19 In lymphoid neoplasms, fewer mature T/NK and B-cells, and a reduced adaptive immune-response are usually observed, however the innate system remains relatively intact to protect against HAIs. 13 HAIs were mostly clinically documented in our study; this is in line with some other studies. 12,20,21 This could be explained by the fact that doctors prefer early empirical therapy over microbiological confirmation of infections.…”

“…Neutropenia was revealed as a risk factor of HAIs in our study, this goes hand in hand with Hui liu et al 13 and Biswal et al 17 who found that neutropenia increases risk of nosocomial infections in haematology ward. Previous studies have demonstrated that neutropenia usually occurs during the first course of induction chemotherapy 17 and this increases the risk of infections among patients undertaking induction chemotherapy.…”

“…6 This rate reached 21.52 per patient-days in a recent Chinese study. 13 However, lower incidences (4.7 per 100 patients) were reported in a Mexican study. 1 Several factors may contribute to these differences in estimating HAIs incidence in haematology-oncology departments, including the sample size, the length of study, the inclusion criteria, the data collection methods as well as the definition of HAIs in the studied population.…”

“…This result was in line with those found in literature. 3,13,17,18 The differences in the immunological and biological mechanisms of the myeloid neoplasm lineages may affect the vulnerability to HAI. In myeloid neoplasms, differentiation and maturation of myeloid stem cells (neutrophils, macrophages, and megakaryocytes) is impaired.…”

“…Hence, chemotherapy is associated with more HAIs. 18 One study showed that the first course of induction chemotherapy is the stage when HAIs are most likely to occur. 17 Induction chemotherapy consists of a combination of myelosuppressive drugs and results in neutropenia in the majority of patients.…”