Comparative analysis of infectious complications with outpatient vs. inpatient care for adults with high-risk myeloid neoplasm receiving intensive induction chemotherapy. Issue 1 (2nd January 2022)

• Record Type: Journal Article
• Authors: Halpern, Anna B.; Othus, Megan; Howard, Nicholas P.; Hendrie, Paul C.; Percival, Mary-Elizabeth M.; Hartley, Garrett A.; Welch, Verna L.; Estey, Elihu H.; Walter, Roland B.
• Is Part Of: Leukemia & lymphoma. Volume 63:Issue 1(2022)
• Page Start: 142
• Page End: 151
• Publication Date: 2022-01-02
• Subjects: Infectious complications -- acute myeloid leukemia -- early hospital discharge -- myeloid leukemias and dysplasias; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2021.1984451
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: 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.