Introduction
Materials and methods
Study design and treatment protocols
Definitions of CDI
Statistical analysis
Results
Baseline characteristics
Characteristic | All | AML with CDI | AML without CDI | p value |
---|---|---|---|---|
Number of patients (n, %) | 415 (100) | 37 (8.9) | 378 (91.1) | |
Median age (median, range) | 59 (18-85) | 58 (22-76) | 59 (18-85) | 0.701 |
Female sex (n, %) | 190 (45.8) | 17 (45.9) | 137 (36.2) | 0.562 |
AML with recurrent genetic abnormalities (n, %) | 176 (42.4) | 18 (48.6) | 158 (41.8) | 0.925 |
AML with myelodysplasia-related changes (n, %) | 56 (13.5) | 4 (10.8) | 52 (13.8) | 0.925 |
Therapy-related myeloid neoplasms (n, %) | 5 (1.2) | 0 (0) | 5 (1.3) | 0.925 |
AML not otherwise specified (n, %) | 175 (42.2) | 15 (40.5) | 160 (42.3) | 0.925 |
Acute leukemias of ambiguous lineage (n, %) | 1 (0.2) | 0 (0) | 1 (0.2) | 0.925 |
Myeloid sarcoma (n, %) | 1 (0.2) | 0 (0) | 1 (0.2) | 0.925 |
Favorable ELN risk group (n, %) | 85 (20.5) | 7 (18.9) | 78 (20.6) | 0.782 |
Intermediate-I ELN risk group (n, %) | 157 (37.8) | 12 (32.4) | 145 (38.4) | 0.782 |
Intermediate-II ELN risk group (n, %) | 91 (21.9) | 10 (27.0) | 81 (21.4) | 0.782 |
Adverse ELN risk group (n, %) | 75 (18.1) | 8 (21.6) | 67 (17.7) | 0.782 |
Clinical findings and outcome in AML patients with and without CDI
Characteristic | AML with CDI | AML without CDI | p value |
---|---|---|---|
Number of patients (n, %) | 37 (8.9) | 378 (91.1) | |
Diagnosed between 2007 and 2012 (n, %) | 25 (67.6) | 163 (43.1) | 0.005 |
Diagnosed between 2013 and 2019 (n, %) | 12 (32.4) | 215 (56.8) | 0.005 |
Length of hospital stay (median, range) | 49 (28-82) | 49 (5–127) | 0.386 |
Days with fever (median, range) | 7 (0-28) | 5 (0–31) | 0.048 |
C-reactive protein (median, range) | 4,58 (0.39–19.42) | 3.99 (0.19–34.66) | 0.312 |
Patients requiring treatment on intensive care unit (n, %) | 7 (18.9) | 67 (17.7) | 0.824 |
Incidence of acute renal failure (n, %) | 7 (18.9) | 71 (18.8) | 1.000 |
Complete remission after induction chemotherapy (n, %) | 25 (67.6) | 236 (62.4) | 0.722 |
Allogenic stem cell transplantation as consolidation therapy (n, %) | 19 (51.4) | 211 (55.8) | 0.608 |
Overall survival (n, %) | 18 (48.6) | 174 (46.0) | 0.863 |
Distribution of anti-infective agents in AML patients with and without CDI
Characteristic | AML with CDI | AML without CDI | p value |
---|---|---|---|
Number of patients (n, %) | 37 (8.9) | 378 (91.1) | |
Cumulative antibiotic exposure to fluoroquinolone, acylaminopenicillin + ß-lactamase inhibitor, carbapenem and glycopeptide (median, range)* | 70 (29–125) | 59 (2–169) | 0.027 |
Cumulative fluoroquinolone exposure (median, range)* | 17 (0–38) | 20 (0–78) | 0.460 |
Cumulative acylaminopenicillin + ß-lactamase inhibitor exposure (median, range)* | 0 (0–23) | 7 (0–56) | 0.009 |
Cumulative carbapenem exposure (median, range)* | 28 (0–50) | 17 (0–72) | 0.001 |
Cumulative glycopeptide exposure (median, range)* | 18 (0–63) | 11 (0–51) | < 0.0001 |
Cumulative exposure to antifungals (median, range)* | 34 (9–54) | 32.5 (0–178) | 0.319 |
Parameter | OR | 95% CI | P value | OR | 95 % CI | p value |
---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | |||||
Female sex | 1.007 | 0.512–1.983 | 0.983 | |||
Age > 60 | 1.232 | 0.623–2.434 | 0.549 | |||
Days with fever | 1.048 | 0.999–1.101 | 0.057 | |||
Cumulative antibiotic exposure to fluoroquinolones, acylaminopenicillin + ß-lactamase inhibitors, carbapenems and glycopeptides* | 1.012 | 1.000–1.024 | 0.059 | |||
Cumulative fluoroquinolone exposure* | 0.959 | 0.959–1.014 | 0.986 | |||
Cumulative acylaminopenicillin + ß-lactamase inhibitor exposure (median, range)* | 0.953 | 0.911–0.996 | 0.034 | |||
Cumulative carbapenem exposure* | 1.029 | 1.009–10.51 | 0.005 | |||
Cumulative glycopeptide exposure* | 1.053 | 1.023–1.083 | < 0.001 | 1.055 | 1.010–1.102 | 0.016 |
Treatment results for CDI
Characteristic | All | Treatment with metronidazole only | Treatment with vancomycin only | Treatment with metronidazol and/or vancomycin | Treatment with fidaxomicin | No treatment |
---|---|---|---|---|---|---|
Number of patients (n, %) | 37 (100) | 23 (62.2) | 3 (8.1) | 7 (18.9) | 1 (2.7) | 3 (8.1) |
Days to treatment response (median, range) | 7 (3–12) | 7 (3–12) | 11 (6–19) | 12 (8–27) | 6 | 2 (0–3) |
Treatment response day 10 (n, %) | 11 (29.7) | 8 (34.8) | 1 (33.3) | 1 (14.3) | 1 (100) | 3 (100) |
Recurrent CDI within 90 days (n, %) | 10 (27.0) | 8 (34.8) | 0 (0) | 2 (28.6) | 0 (0) | 0 (0) |