Use of carbapenems and glycopeptides increases risk for Clostridioides difficile infections in acute myeloid leukemia pa
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ORIGINAL ARTICLE
Use of carbapenems and glycopeptides increases risk for Clostridioides difficile infections in acute myeloid leukemia patients undergoing intensive induction chemotherapy Olivier Ballo 1 & Eva-Maria Kreisel 1 & Fagr Eladly 1 & Uta Brunnberg 1 & Jan Stratmann 1 & Peter Hunyady 2 & Michael Hogardt 3,4,5 & Thomas A. Wichelhaus 3,4,5 & Volkhard A. J. Kempf 3,4,5 & Björn Steffen 1,6 & Joerg J. Vehreschild 1 & Maria J. G. T. Vehreschild 4,7 & Fabian Finkelmeier 2,8 & Hubert Serve 1,6 & Christian H. Brandts 1,6,9 Received: 10 August 2020 / Accepted: 17 September 2020 / Published online: 24 September 2020 # The Author(s) 2020
Abstract Patients with acute myeloid leukemia (AML) are often exposed to broad-spectrum antibiotics and thus at high risk of Clostridioides difficile infections (CDI). As bacterial infections are a common cause for treatment-related mortality in these patients, we conducted a retrospective study to analyze the incidence of CDI and to evaluate risk factors for CDI in a large uniformly treated AML cohort. A total of 415 AML patients undergoing intensive induction chemotherapy between 2007 and 2019 were included in this retrospective analysis. Patients presenting with diarrhea and positive stool testing for toxin-producing Clostridioides difficile were defined to have CDI. CDI was diagnosed in 37 (8.9%) of 415 AML patients with decreasing CDI rates between 2013 and 2019 versus 2007 to 2012. Days with fever, exposition to carbapenems, and glycopeptides were significantly associated with CDI in AML patients. Clinical endpoints such as length of hospital stay, admission to ICU, response rates, and survival were not adversely affected. We identified febrile episodes and exposition to carbapenems and glycopeptides as risk factors for CDI in AML patients undergoing induction chemotherapy, thereby highlighting the importance of interdisciplinary antibiotic stewardship programs guiding treatment strategies in AML patients with infectious complications to carefully balance risks and benefits of anti-infective agents. Keywords AML . CDI . Induction chemotherapy
Introduction Acute myeloid leukemia (AML) is one of the most aggressive hematological malignancies arising from transformed myeloid
precursor cells. Curative treatment with induction chemotherapy is due to its high toxicity only initiated in patients with no or only limited comorbidities up to 60–75 years of age [1–3]. Disease- and therapy-related immunosuppressions going
* Olivier Ballo [email protected]
4
University Center for Infectious Diseases, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
* Christian H. Brandts [email protected]
5
University Center of Competence for Infection Control, Frankfurt Giessen -, Marburg, Hessen, Germany
6
German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
7
Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
8
Frankfu
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