Fever of Unknown Origin and Multidrug-Resistant Organisms Colonization in Aml Patients.

Abstract

Abstract. Background: Colonization by multidrug-resistant organisms (MDRO) is a frequent complication in hematologic departments, which puts patients at risk of life-threatening bacterial sepsis. Fever of unknown origin (FUO) is a condition related to the delivery of chemotherapy in hematologic malignancies, in which the use of antibiotics is debated. The incidence, risk factors, and influence on the outcome of these conditions in patients with acute myeloid leukemia (AML) are not clearly defined.Methods: We retrospectively analyzed 132 consecutive admissions of non-promyelocytic AML patients at the Hematology Unit of the University Tor Vergata in Rome between June 2019 and February 2022. MDRO swab-based screening was performed in all patients on the day of admission and once weekly after that. FUO was defined as fever with no evidence of infection.Results: Of 132 consecutive hospitalizations (69 AML patients), MDRO colonization was observed in 35 cases (26%) and resulted independently related to a previous MDRO colonization (p=0.001) and length of hospitalization (p=0.03). The colonization persistence rate in subsequent admissions was 64%. MDRO-related bloodstream infection was observed in 8 patients (23%) and correlated with grade III/IV mucositis (p=0.008) and length of hospitalization (p=0.02). FUO occurred in 68 cases (51%) and correlated with an absolute neutrophilic count <500μ/L at admission (0.04).Conclusion: In our experience, MDRO colonization is a frequent and difficult-to-eradicate condition that can arise at all stages of treatment. Prompt discharge of patients as soon as clinical conditions allow could limit the spread of MDRO. In addition, the appropriate use of antibiotics, especially in the case of FUO, and the contraction of hospitalization length, when feasible, are measures to tackle the further spread of MDRO.

A Rare Case of Acute Myeloid Leukemia Initially Presenting With Fever of Unknown Origin and Rapidly Progressing Pericardial Effusion

“…AML is a hematologic malignancy associated with various clinical manifestations, including extramedullary involvement. Pericardial effusion, although rare, can be a manifestation of AML and may present with FUO [ 4 ]. The association between AML, pericardial effusion, and FUO poses diagnostic challenges and requires a comprehensive medical approach.…”

“…AML patients may experience febrile episodes categorized as FUO, making it difficult to precisely determine the fever's source. Studies suggest that FUO in the context of AML lacks clearly defined causes, further complicating the diagnostic process [ 3 , 4 ].…”

“…AML patients may experience febrile episodes categorized as FUO, making it difficult to precisely determine the fever's source. Studies suggest that FUO in the context of AML lacks clearly defined causes, further complicating the diagnostic process [3,4]. Pericardial effusions are not uncommon in patients already diagnosed and being treated for AML (about 21%), but during the initial diagnosis of leukemia, pericardial effusions are rare [5].…”

Phenotypic and Genotypic Analysis of Bacterial Pathogens Recovered from Patients Diagnosed with Fever of Unknown Origin in Egypt

“…A further rise in the prevalence of the MDR strains was also evident during the pandemic of COVID-19 [ 23 , 26 , 27 , 28 ]. In FUO, MDR infections have been recently linked to prior colonization by MDR organisms that were in turn linked to a longer hospitalization [ 29 ].…”

Immunotherapy in Acute Myeloid Leukemia: A Literature Review of Emerging Strategies

“…This may result, on the one hand, in an incomplete clearance of the blasts and, on the other hand, in harm to the healthy HSC compartment. In addition, there are side effects, both common to conventional AML management strategies, such as high rates of opportunistic and nosocomial infections due to cytopenia [38][39][40], and those related to specific targets, such as veno-occlusive disease, due to the expression of CD33 on hepatic Kupffer cells, observed also in patients treated with Gemtuzumab Ozogamicin [41], and cytokine release syndrome (CRS), due to activation of bystander immune cells and non-immune cells, such as endothelial cells, after binding the target antigen [42].…”