PB2594: BACTEREMIA AND FEBRILE NEUTROPENIA IN PATIENTS TREATED FOR ACUTE LEUKEMIA

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Acute leukemia represents a risk factor for profound and prolonged neutropenia. This state of immunosuppression exposes the patient to severe bacteremia, which is a major cause of morbidity and mortality. Therefore, rapid and adequate management with empirical and appropriate antibiotic therapy is essential. Aims: The purposes of this study are to describe the clinical and biological characteristics of bacteremia associated with febrile neutropenia in patients treated for acute leukemia, to study the resistance profile of the isolated bacterial strains and to evaluate the prescription of empirical antibiotic therapy in our department. Methods: This was a retrospective descriptive and monocentric study of bacteremia occurring in patients with febrile neutropenia treated for acute leukemia, conducted at the Hematology Department in the University Hospital of Monastir (Tunisia) between April 2019 and June 2021. Results: Our study included 27 patients. Forty-eight percent of them had acute myeloid leukemia. The median age was 31 years (range: 2 - 64 years). Fever was the only clinical sign in 48% of febrile neutropenia episodes. Veinitis was the most frequent clinical localization in the bacteremia episodes (29.6% of cases). Eleven percent of the bloodstream infections were associated with sepsis initially, of which seven percent had progressed to septic shock. At the onset of fever, neutropenia was profound (neutrophils < 100/mm3) in 63% of cases and prolonged (duration > 7 days) in 37% of cases. Fifty-four bacteremia were included in our study, in which 67 germs were identified. In fact, 15% of the bacteremia were polymicrobial. A predominance of Cocci Gram-Positive bacteremia compared with Gram Negative ones was observed (68.7% vs. 29.8%). Coagulase-negative Staphylococci was the most frequently detected Gram-Positive germ with resistance to methicillin noted in 68% of cases, whereas Escherichia coli and Klebsiella pneumoniae were the most common Gram-Negative strains. Extended-spectrum beta-lactamase–producing Enterobacteriaceae were identified in 17% of the blood stream infections due to Gram-negative bacteria. Compared to the European Conference on Infections in Leukemia (ECIL) and to the Infectious Diseases Society of America (IDSA) recommendations, the prescription of the first-line antibiotics in our department was appropriate in 76% of cases. However, it was effective in only 44% of cases. According to this study, we were able to validate the prescription of piperacillin tazobactam as an empirical monotherapy to treat febrile neutropenic patients in our department. Summary/Conclusion: Although compliance with the international recommendations in therapeutic conduct remains essential, the prescription of antibiotics must be guided by the ecology of each department and adapted according to the resistance profile of the isolated germs. Keywords: Infection, Acute leukemia