Infections on Different Chemotherapy Cycles in Adult Patients With Acute Lymphoblastic Leukemia Treated With All-2009 Protocol

The aim of the study was to evaluate the profile and risk factors for acquisition of infections in patients with de novo multiple myeloma (MM) on the 1st chemotherapy cycle (CC).Materials and methods. Study included patients with de novo MM undergoing chemotherapy from January 2013 till November 2017 in National Research Center for Hematology, Russia.Results. A total of 156 patients with de novo MM (median age 61 years) were included in the study. Follow-up period was 21–82 days (median 26 days), first CC contained bоrtezomib. Infections occurred in 77 (49.4 %) of patients with MM, from them 29 (37.7 %) – on admission, 48 (62.3 %) – throughout treatment. Solitary infections were in 47 (61%) of patients, multiple infections – in 30 (39 %) of patients. The most prevalent type of infection was pneumonia (62.3 %), followed by urinary tract infections (27.3 %) and herpesvirus infections (24.7 %). 30% of patients with infections were afebrile. Significant risk factors associated with infections at admission and during CC were ECOG score 4, anemia, hypercalcemia, humoral immunodeficiency, admission from other hospital, use of antibiotics prior to first CC. Additional risk factors for infections at admission were Durie–Salmon stage III MM, paresis, lower extremity paraplegia and dysfunction of the pelvic organs, whereas during treatment – ISS stage III MM and renal failure. Infections were uncommon in patients with ISS stage I MM (7.8 %). Mortality after 1st CC was 1.9 % caused by pneumonia and acute respiratory failure.Conclusions. Patients with de novo MM undergoing 1st CC had high incidence of infections with a prevalence of pneumonia. Factors associated with infections were stage III MM, serious illness, admission from other hospital, humoral immunodeficiency, and renal failure.

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Infectious complications in patients with multiple myeloma on first chemotherapy cycle

Новикова

Клясова

Грибанова

et al. 2018

Onkogematologiâ

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<i>In vitro</i> activity of cefepime / sulbactam and biapenem against Enterobacterales and <i>Pseudomonas aeruginosa</i> isolated from blood culture from patients with hematological diseases: results of a multicenter study

Klyasova,

Fedorova,

Khrulnova

et al. 2023

Onkogematologiâ

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Background. Activity against Gram negative bacteria, including Pseudomonas aeruginosa, is required for first line antibiotic therapy in patients with febrile neutropenia.Aim. To study in vitro activity of cefepime / sulbactam and biapenem against Enterobacterales and P. aeruginosa strains in patients with bloodstream infection and hematologic diseases.Materials and methods. Susceptibility of cefepime / sulbactam and biapenem in comparison to anibiotics used for febrile neutropenia was studied among Escherichia coli (n = 100), Klebsiella pneumoniae (n = 100), Enterobacter cloacae complex (n = 30), and P. aeruginosa (n = 70) isolated from blood culture (2017–2021) from patients with hematological diseases and infection in 4 Russian hospitals. Activity was determined by broth microdilution method, interpretation was according to Clinical and Laboratory Standards Institute (CLSI, 2022) and European Committee on Antimicrobial Susceptibility Testing (EUCAST , 2022) criteria, for cefepime / sulbactam we used cefepime criteria. The values of the minimum inhibitory concentration (MIC), MIC50 and MIC90 were studied.Results. MIC90 of cefepime / sulbactam were lower in comparison with piperacillin / tazobactam for E. coli without extended spectrum beta-lactamase (ESBL) production (0.125 μg / mL vs 1 μg / mL), K. pneumoniae without ESBL-production (0.125 μg / mL vs 2 μg / mL), K. pneumoniae with ESBL-production (32 μg / mL vs 128 μg / mL) with comparable frequency of resistant strains. For P. aeruginosa, preference of cefepime / sulbactam over piperacillin / tazobactam were found both by lower MIC90 (8 μg / mL vs 32 μg / mL) and by lower frequency of resistant strains according to EUCAST criteria (4.3 % vs 25.7 %). The MIC90 values of cefepime / sulbactam compared to cefepime and ceftazidime were 4 times lower for K. pneumoniae with ESBL-production and for Enterobacter cloacea complex, 2–4 times lower for P. aeruginosa, 64 times lower for E. coli with ESBL production.Values of biapenem MIC90 for E. coli without and with ESBL-production (0.032 μg / mL) were in intermediate position between meropenem and imipenem; for K. pneumoniae without ESBL-production – identical to imipenem (0.064 μg / mL), for K. pneumoniae with ESBL – minimal (0.064 μg / mL) against imipenem and meropenem; for E. cloacae – comparable to meropenem (0.032 μg / mL). For P. aeruginosa without carbapenemase production, the MIC50 / MIC90 values of biapenem (0.125 / 16 μg / mL) were minimal compared to meropenem (0.25 / 64 μg / mL) and imipenem (0.5 / 64 μg / mL).Conclusion. The favorable in vitro activity of cefepime / sulbactam and biapenem are fully comply with the requirements for febrile neutropenia.

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Analysis of etiologic structure and antibiotic resistance of the main pathogens of infectious complications in patients with acute leukemia

Korolenko,

Kravchenko,

Mikhailova

et al. 2023

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Objective. Analyze the etiological structure of infectious complications in patients with acute leukemia and determine the sensitivity to antibacterial drugs of the main pathogens.Materials and methods. The results of bacteriological cultures and antibiograms of 177 patients with acute leukemia and infectious complications for the period 2019–2021 were retrospectively studied.Results. In 2019, the frequency of isolation of Gr+ flora was 45.28% and Gr- was 54.72%; in 2020 the percentage of Gr+ bacteria was 34.62%, Gr− was characterized by 65.38%; in 2021 it was 41.3% and 58.7% respectively, (x2=0.20, p=0.66). In 2019, one of the main pathogens was Klebsiella pneumoniae (21%), which retained its positions by 2021 (13%; x2=0.05, p=0.82). The causative agent showed polyresistance to many antibiotics, except for imipenem (100%) and fosfоmycin (100%). In the period 2020–2021 Klebsiella pneumoniae began to compete with Stenotrophomonas maltophilia, which showed an increase in the detection rate from 11% to 17% (x2=29.46, p=0.0001). Having polyresistance, the pathogen showed 100% sensitivity only to ticarcillin/clavulanate and co-trimoxazole.Conclusion. In the absence of changes between the frequency of isolation of Gram-positive and Gram-negative microorganisms, the increase in the number of strains of Gram− microorganisms (K. pneumoniae and S. maltophilia) with multiple antibiotic resistance among the causative agents of infectious complications in patients with acute leukemia necessitates continuous microbiological monitoring to improve the tactics of antibacterial drugs.

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Infections on Different Chemotherapy Cycles in Adult Patients With Acute Lymphoblastic Leukemia Treated With All-2009 Protocol

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Infectious complications in patients with multiple myeloma on first chemotherapy cycle

Infectious complications in patients with multiple myeloma on first chemotherapy cycle

<i>In vitro</i> activity of cefepime / sulbactam and biapenem against Enterobacterales and <i>Pseudomonas aeruginosa</i> isolated from blood culture from patients with hematological diseases: results of a multicenter study

Analysis of etiologic structure and antibiotic resistance of the main pathogens of infectious complications in patients with acute leukemia

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