SEPSIS IN ACUTE LEUKEMIA; EPIDEMIOLOGY; PATHOPHYSIOLOGY, ETIOLOGY AND TREATMENT

Abstract

Acute leukemia is a group of aggressive malignant diseases, associated with a high degree of both morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to diseases both due to factors related to the disease itself, factors attributed to treatment and specific individual risk factors in each individual patient. Patients with chemotherapy induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular this applies to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) and extended spectrum beta-lactamase resistance (ESBL). Treatment of sepsis in leukemia patients includes the use of broad-spectrum antibiotics and international guidelines regarding treatment have been developed. Nevertheless, one should implant knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. In this review, we discuss infectious diseases in acute leukemia with major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group.