医学
髓系白血病
内科学
菌血症
泊沙康唑
诱导化疗
化疗
氟康唑
风险因素
重症监护医学
肿瘤科
抗生素
抗真菌
两性霉素B
微生物学
生物
皮肤病科
作者
Anna B. Halpern,Megan Othus,Nicholas P. Howard,Paul C. Hendrie,Mary‐Elizabeth M. Percival,Garrett A. Hartley,Verna L. Welch,Elihu H. Estey,Roland B. Walter
标识
DOI:10.1080/10428194.2021.1984451
摘要
We recently reported an early hospital discharge (EHD) care strategy following intensive acute myeloid leukemia (AML)-like chemotherapy is safe. To evaluate its impact on infectious outcomes, we compared all adults treated from 8/1/2014 to 7/31/2018 discharging within 72 h of completing chemotherapy (EHD) with hospitalized patients (controls) across 354 induction and 259 post-remission cycles. While overall outcomes were similar, gram-positive bacteremias were more common in EHD patients than control (p<.001), although they received fewer days of IV antimicrobials (p< .001). Notably, cumulative infection risks in EHD patients were similar after induction and post-remission therapy. In multivariable analysis, only EHD status was independently associated with risk for gram-positive bacteremia (p= .01), whereas the only independent risk factor for fungal infection was fluconazole (vs. posaconazole) use (p< .001). The observation of increased rates of gram-positive bacteremias with EHD identifies improvements in catheter management as one area to further increase the safety of this care approach.
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