Infection risk and role of antibiotic prophylaxis in acute myeloid leukemia patients receiving lower intensity chemotherapy: A literature review
Loading...
Date
2024-05-15
Authors
Castro, Daniella
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Patients with acute myeloid leukemia (AML) are at high risk for infections due to chemotherapy-induced neutropenia. AML patients who receive lower dose chemotherapy are typically elderly patients who have comorbid conditions or have failed initial therapy. Antibiotic prophylaxis use is not clearly understood in this patient population, but early studies were conducted to study the incidence of infections and the use of antibiotic prophylaxis to reduce the risk of infections. The purpose of this literature review was to determine the incidence of infections in patients with AML, if antibiotic use leads to reduced incidence of infections and the role of antibiotic prophylaxis in patients with AML who received lower intensity chemotherapy. This review searched the PubMed database for relevant papers that addressed the research question using the following search terms: leukemia, infections, febrile neutropenia and chemotherapy. Four retrospective studies were identified using this approach and are included in this review. Comparing the four retrospective studies, there was a significant number of patients infected with Gram negative bacteria and the most common pathogens were Enterobacteriaceae and Pseudomonas aeruginosa. Increased incidence of infections were observed during cycles 1 and 2 of chemotherapy. In one of the studies, despite use of antibiotic prophylaxis, infections occurred and induced the growth of antibiotic resistant bacteria. In another study, the use of antibiotic prophylaxis significantly decreased the incidence of infections in patients with severe neutropenia. Due to the increased incidence of infections in the early chemotherapy cycles, antibiotic prophylaxis has a potential role during this time period especially for severely neutropenic patients. Febrile neutropenia could be the only sign of infection for AML patients so close monitoring during this time period would allow for early detection of infections and prompt treatment with antibiotics. Further studies are required in order to clarify the role of antibiotic prophylaxis, its indication and duration of use in this patient population.