抗感染疗程对急性髓系白血病患者巩固化疗期伴发革兰阴性菌血流感染转归的影响

OBJECTIVE: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. METHODS: Data were collected retrospectively from 591 patients enrolled from the registered “A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202” treatment protocol between September 2010 and January 2016 in different treatment cycles. RESULTS: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0–5.62)×10(9)/L, median neutropenia duration was 9 (3–26) days, median interval of antibiotics administration was 7 (4–14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024–6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309–2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187–2.352). No infection associated death occurred within 7 or 30 days in both groups. CONCLUSION: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.