Epidemiologie von Infektionen mit multiresistenten Erregern bei akuter myeloischer Leukämie

Weber, Katja (2021): Epidemiologie von Infektionen mit multiresistenten Erregern bei akuter myeloischer Leukämie. Dissertation, LMU München: Medizinische Fakultät

Abstract

Infection and colonisation with focus on resistant bacteria in AML patients receiving intensive chemorherapy. Background: Infections and colonization caused by resistant bacteria are a widespread problem and require complex hygienic efforts. In this thesis the colonization and infection with problematic resistant bacteria (VRE, 3/4MRGN, MRSA) and C.difficile in AML-patients were explored for a period of six years (2011-2016) using retrospective data. Methods: 119 consecutive patients, who received chemotherapy (119 induction cycles with SHAM and 66 consolidation) between 01.01.2011 and 31.12.2016 were analyzed. We retrospectively analyzed all available data from patient documentation, microbiological, radiological and labaratory findings. Follow up ended with discharge. Patients were analyzed regarding developing fever in neutropenia and fulfilling criteria of sepsis (BSI + HR >100/min; T >38°C; RR >20/min; neutropenia. BSI + two criteria = sepsis) or not. Results: Patients, who underwent induction therapy had a mean duration of neutropenia of 29 days patients receiving consolidation therapy of 16 days. All of the induction patients developed fever (vs. 97% of the consolidation patients). Microbiological screening procedures were performed in 18% (22) of the inductions no positive result. Screenings were done in 18% (12) of consolidations and showed two positive results. There is an increasing trend to do screenings over the years, with most frequent tests in 2016. The criteria of sepsis were fulfilled in 56% (67) of all 119 patients in induction, and in 45% (30) of all 66 patients in consolidation. Infection episodes with detection of VRE or 3MRGN in blood culture were seen in 5 patients with induction and in 3 patients with consolidation. All patients were treated according to resistance testing. Detection of VRE or 3/4MRGN in other media than blood culture were seen in 10 induction patients and 9 consolidation patients and interpreted as colonisation. 21% (14) out of 66 patients with consolidation had complications (infection or colonisation) with problematic bacteria, seven of these cases showed the same germ (VRE or 3MRGN) as detected in induction. During the six years we see an increase of positive results for resistant bacteria in induction, starting and reaching a plateau in 2014 (6 positive results). In consolidation the peak was 2015 (6 positive results) with a decrease in 2016 (2). Clostridium difficile infections (C. diff associated diarrhea, CDAD) were seen in 6 patients receiving induction therapy and in 4 patients during consolidation. Conclusion: complications (Infections/colonisations) with bacteria carrying resistances to commonly used antibiotics and CDAD are high in AML patients (19%, n=185). The increasing number of resistant isolates reported in national and international surveillance studies should initiate a discussion about their causes and about strategies to prevent the transmission in AML patients.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: AML, multiresistente Erreger, Infektionen
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 4. Februar 2021
• 1. Bericht­erstatter:in: Ostermann, Helmut