TY - JOUR

T1 - Epidemiology of bloodstream infections in patients with chronic lymphocytic leukemia

T2 - a longitudinal nation-wide cohort study

AU - Andersen, Michael Asger

AU - Moser, Claus Ernst

AU - Lundgren, Jens

AU - Niemann, Carsten Utoft

N1 - Correction: https://doi.org/10.1038/s41375-020-0992-9

PY - 2019/3

Y1 - 2019/3

N2 - Patients with chronic lymphocytic leukemia (CLL) have a high risk of bloodstream infections (BSI). BSI cause significant morbidity and mortality among CLL patients; approximately one-third of fatalities in CLL list infections as cause of death. All CLL patients in Denmark diagnosed between 2008 and 2016 were followed through registries for the event of a BSI. Patient characteristics and bacterial findings were analyzed separately for treatment-naive and treated patients. A total of 3677 and 1020 patients with CLL were followed as treatment-naive and treated patients, respectively. We identified 145 cases of Gram-positive bacteremia. Streptococcus pneumoniae accounted for 32 (22%) cases, while Staphylococcus aureus was found 30 times (21%). Gram-negative microorganisms were found in 166 (46%) cases. Escherichia coli accounted for 77 (46%) cases. Lastly, we identified six episodes of candidemia of which five (83%) were fatal within 30 days of the infection. Based on increased frequency of S. pneumoniae and Pseudomonas aeruginosa and the high mortality of candidemia in CLL, empirical antibiotics with double coverage for S. pneumoniae and P. aeruginosa is recommended; upon suspected or proven candidemia, treatment with broad-spectrum fungicidal agents are recommended.

AB - Patients with chronic lymphocytic leukemia (CLL) have a high risk of bloodstream infections (BSI). BSI cause significant morbidity and mortality among CLL patients; approximately one-third of fatalities in CLL list infections as cause of death. All CLL patients in Denmark diagnosed between 2008 and 2016 were followed through registries for the event of a BSI. Patient characteristics and bacterial findings were analyzed separately for treatment-naive and treated patients. A total of 3677 and 1020 patients with CLL were followed as treatment-naive and treated patients, respectively. We identified 145 cases of Gram-positive bacteremia. Streptococcus pneumoniae accounted for 32 (22%) cases, while Staphylococcus aureus was found 30 times (21%). Gram-negative microorganisms were found in 166 (46%) cases. Escherichia coli accounted for 77 (46%) cases. Lastly, we identified six episodes of candidemia of which five (83%) were fatal within 30 days of the infection. Based on increased frequency of S. pneumoniae and Pseudomonas aeruginosa and the high mortality of candidemia in CLL, empirical antibiotics with double coverage for S. pneumoniae and P. aeruginosa is recommended; upon suspected or proven candidemia, treatment with broad-spectrum fungicidal agents are recommended.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents/therapeutic use

KW - Bacteremia/drug therapy

KW - Bacteria/drug effects

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Leukemia, Lymphocytic, Chronic, B-Cell/microbiology

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Retrospective Studies

UR - https://doi.org/10.1038/s41375-020-0992-9

U2 - 10.1038/s41375-018-0316-5

DO - 10.1038/s41375-018-0316-5

M3 - Journal article

C2 - 30546080

VL - 33

SP - 662

EP - 670

JO - Leukemia

JF - Leukemia

SN - 0887-6924

IS - 3

ER -