Dr Balasaheb Wanve
Christian Medical College, India
Title: Bacterial infections and their sensitivity pattern during intensive phase of acute leukaemia therapy in paediatric age group and their impact on mortality from year 2005 to 2016
Biography
Biography: Dr Balasaheb Wanve
Abstract
Introduction:
Chemotherapy for acute lymphoblastic leukaemia consist of intensive phase which is the backbone for inducing haematological remission. However, this phase is complicated by increased susceptibility to infections. Increased susceptibility to infections is caused by neutropenia, deranged B cell and partly T cell function secondary to leukaemia and its therapy. This analysis was done to study the incidence of infection during first six months of curative chemotherapy for acute lymphoblastic leukaemia.
Methods:
This is a retrospective chart-based review of all patients <21 years of age who were treated for acute lymphoblastic leukemia in the department of Hematology CMC Vellore between 2006 and 2016. Data was collected from the electronic medical record available to the hospital.
Results:
A total of 834 children were diagnosed to have ALL between January 2006 to December 2016, out of which 247 (29.6%) were girls and 587 (70.4%) were boys. They were risk stratified into 3 groups, 125 (15%) formed standard risk, 675 (80.9%) formed intermediate risk and 34 (4.1%) formed high risk group.
Bacterial infections occurred in 117 (14%) patient, of which of which 78 (66.6%) were due to gram negative bacteria and 54 (47%) were due to gram positive bacteria. 7 (11%) patients had dual blood culture positivity. Of patient with gram negative bacterial infection the common organism detected was klebseilla 25 (32%) followed by pseudomonas 24 (30.7%), NFGNB 15 (19.2%), E coli 14 (17.9%).
Sensitivity pattern showed pansensitive GNB growth in 23 (29.4) patient, extended spectrum beta lactamase GNB growth in 41 (52.5%) and carbapenem resistant GNB growth in 12 (15.3%).
Year 2005 to 2010 there were 53 (45.2%) patients with documented fungal infection as compare to 63 (54.7%) patients from 2011 to 2016. There was no statistically significant increase in the infection rate (P = 0.3). Moratality rate due to bacterial infection was 17 (14.5%).
The Kaplan Mayer analysis showed poor overall survival who developed documented bacterial infection during the intensive phase of chemotherapy.
Conclusions:
Proven bacterial infections were documented in 14% of patients during induction. There was statistically significant difference noted between mortality in patient with proven infection and those without any infections.