Real-world management of infection during chemotherapy for acute leukemia in Japan: from the results of a nationwide que
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ORIGINAL ARTICLE
Real‑world management of infection during chemotherapy for acute leukemia in Japan: from the results of a nationwide questionnaire‑based survey by the Japan Adult Leukemia Study Group Shun‑ichi Kimura1 · Hiroyuki Fujita2 · Hiroshi Handa3 · Nobuhiro Hiramoto4 · Naoko Hosono5 · Hitoshi Minamiguchi6 · Tsutomu Takahashi7 · Hideaki Kato8 · Takaaki Ono9 · Yoshinobu Kanda1,10 · Hitoshi Kiyoi11 · Itaru Matsumura12 · Yasushi Miyazaki13 · Japan Adult Leukemia Study Group (JALSG) Received: 29 April 2020 / Revised: 5 June 2020 / Accepted: 11 June 2020 © Japanese Society of Hematology 2020
Abstract We conducted a nationwide questionnaire-based survey in 2019 following 2001, 2007 and 2013 surveys to clarify the realworld management of infection during chemotherapy for acute leukemia in Japan. An online questionnaire was sent through SurveyMonkey® to member institutions of the Japan Adult Leukemia Study Group in June 2019. The questionnaire consisted of 52 multiple-choice questions covering prophylactic measures, screening and diagnostic tests, empirical antibiotic therapy, antifungal management, the usage of granulocyte-colony stimulating factor, and vaccinations against influenza and pneumococcus during intensive chemotherapy for acute leukemia. Questions associated with antimicrobial stewardship were also included. Usable responses were received from 163 of 218 (74.8%) institutions. Approximately, half (52.2%) of the institutes did not have infectious disease department. As antibiotic prophylaxis, fluoroquinolones (62%) were most commonly used in induction chemotherapy for acute myeloid leukemia. No prophylaxis accounted for 19% of the institutions, which has gradually increased compared to previous surveys. In empirical antibiotic therapy for febrile neutropenia, monotherapy with β-lactam antibiotics was the most commonly used first-line therapy. De-escalation was not considered in 42.2% of the institutions. In conclusion, this study clarified the real-world management of infection during intensive chemotherapy for acute leukemia in 2019 and raised future issues in Japan. Keywords Acute leukemia · Antibiotic therapy · Febrile neutropenia · Antimicrobial stewardship · Antifungal therapy
Introduction Infectious complication is a common and potentially lifethreatening situation during intensive chemotherapy for acute leukemia [1]. Appropriate prophylactic use, careful monitoring and prompt treatment are mandatory [2]. At the same time, antimicrobial resistance has become a serious issue worldwide [3]. For many years, antimicrobial stewardship has been advocated, encouraging appropriate management for reducing the emergence of antimicrobial resistant Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12185-020-02921-x) contains supplementary material, which is available to authorized users. * Shun‑ichi Kimura [email protected] Extended author information available on the last page of the article
bacteria [4, 5]. Although evidence on de-escalation or stoppi
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