A population‐based study on serious inpatient bacterial infections in patients with chronic lymphocytic leukemia and their impact on survival

Abstract

Objective: Infections in chronic lymphocytic leukemia (CLL) have been thoroughly investigated in the setting of clinical trials and single-center studies. However, large cohort studies on real-world data and studies on temporal trends are lacking. We performed a nationwide study on serious bacterial infections in CLL. Methods: Using high-quality Swedish government-based registries, 13 009 CLL patients diagnosed in 1982-2013 and their 49 380 matched controls were included. Results: Overall, CLL patients had an increased risk of serious inpatient bacterial infections with a hazard ratio (HR) 5.32 and 95% confidence interval (95% CI) 5.11-5.53, and the highest risk was observed for septicemia (HR 6.91, 95% CI 6.46-7.39) and lung infections (5.91, 5.64-6.18). The risk of serious inpatient bacterial infections decreased overtime with HR 0.87 (0.81-0.94) and HR 0.76 (0.70-0.82) in 1993-2002 and 2003-2013, respectively, compared to 1982-1992. CLL patients had an increased risk of death following a serious inpatient bacterial infection compared to matched CLL patients, and the risk was highest in the first 12 months after the infection (HR 5.48, 95% CI 5.11-5.90). Conclusion: We have, in this nationwide study, characterized the risk of serious bacterial infections in CLL patients and, importantly, depicted that the risk has decreased overtime. K E Y W O R D S chronic lymphocytic leukemia, immunology and infectious diseases, lymphoproliferative diseases S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Steingrímsson V, Gíslason GK, Aspelund T, et al. A population-based study on serious inpatient bacterial infections in patients with chronic lymphocytic leukemia and their impact on survival.

Cutaneous malignancies in chronic lymphocytic leukemia

“…Enhanced ROS production from neutrophils can contribute to T and NK cell dysfunction 87 . Additionally, neutrophils from CLL patients have reduced responses to bacterial endotoxin, 87 and CLL patients are at disproportionately higher risk of developing serious bacterial infections, with one large study describing a greater than five times elevated risk of development of serious bacterial infections amongst CLL patients compared to the general population 102,103 …”

“…87 Additionally, neutrophils from CLL patients have reduced responses to bacterial endotoxin, 87 and CLL patients are at disproportionately higher risk of developing serious bacterial infections, with one large study describing a greater than five times elevated risk of development of serious bacterial infections amongst CLL patients compared to the general population. 102,103 Patients with CLL have alterations in several components of both the adaptive and innate immune systems. This results in an acquired state of immunodeficiency, which facilitates the development of cutaneous malignancies.…”

Use of a Victorian statewide surveillance programme to evaluate the burden of healthcare‐associated Staphylococcus aureus bacteraemia and Clostridioides difficile infection in patients with cancer

“…Staphylococcus aureus bacteraemia (SAB) and Clostridioides difficile infection (CDI) are significant healthcareassociated infections leading to morbidity and mortality in hospitalised patients. [1][2][3][4] Immunocompromised patients are at increased risk for acquisition of infections and complications. 5 Surveillance and reporting of these infections are necessary to support prevention programmes in healthcare, as well as enabling meaningful inter-hospital comparisons and review of quality improvement activities.…”

“…Staphylococcus aureus bacteraemia (SAB) and Clostridioides difficile infection (CDI) are significant healthcare‐associated infections leading to morbidity and mortality in hospitalised patients 1–4 . Immunocompromised patients are at increased risk for acquisition of infections and complications 5 .…”