성인 급성 백혈병에 있어서 감염증에 관한 고찰

Abstract

Objectives: Patients with acute leukemia have a long-term disease free survival due to improvement of chemotherapy. But the infection is the most important morbidity and mortality and is the single commonest complication resulting in an early death after chemotherapy. Therefore the effective treatment and preventive strategies of these infection is essential in order that more patients may achieve a complete remission and long-term disease free survival. The purpose of this study was to determine the recent incidence of fever/infection and to evaluate antimicrobial usage among adult acute leukemic patients. Methods: The records of 172 patients from a consecutive series of 350 admission episode between January 1990 to July 1994 were reviewed retrospectively. Datas were analyzed to compare the infectious disease complications and antimicrobial usage for patients receiving various chemotherapy for a specific phase of leukemia treatment. Results: 1) Febrile episodes were developed in 258 of 350 admission session. The microbiologically de5ned infection (MDI) & clinically defined infection (CDI) were developed in 44.8% and 49.2% of episodes, respectively. There was a 92% rate of febrile episodes among the patients receiving salvage chemotherapy. Fever was developed in 75%, 53%, and 70% in cases receiving remission induction chemotherapy, consolidation therapy, and intensified consolidation therapy, respectively. 2) The most frequent site of infection was lung (36%). Coagulase-negative staphylacocci was the most common causative organism of MDI and bacteremia. 3) The rate of overall response to antimicrobial therapy was 72.9%. The rate of overall response to antimicrobial therapy during the intensified consolidation, consolidation therapy, and induction chemotherapy was over than 75% (90.5%, 87.6%, 79.6% respectively). 4) The initial antimicrobial therapy was not modified in 45 of 258 febrile episodes. Modification of antibiotics was carried out in only 36 cases according to the results of primary bacterial culture and sensitivity tests. The initial response of initial empiric antimicrobials was 23.6%, The initial response rate of the addition of vancomycin/teicoplanin, and amphotericin-B was 21.7% and 15.2%, respectively. The cumulative rate of initial response for antimicrobials described above was 60.5%. Among the cases receiving amphotericin-B, probable fungal infection was 23.7%, while the suspected fungal infection was 61%. Conclusion: The development of intensive treatment modalities far acute leukemia has altered the encountered infectious disease problem. Although our management guidelines for infections were of relevant, more effective approaches should be evaluated by considering the changing spectrum of microbials and by using more effective prophylactic and treatment modalities including new antimicrobials.