1. Comparative analysis of infectious complications with outpatient vs. inpatient care for adults with high-risk myeloid neoplasm receiving intensive induction chemotherapy.
- Author
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Halpern AB, Othus M, Howard NP, Hendrie PC, Percival MM, Hartley GA, Welch VL, Estey EH, and Walter RB
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Humans, Inpatients, Outpatients, Retrospective Studies, Induction Chemotherapy adverse effects, Leukemia, Myeloid, Acute complications, Leukemia, Myeloid, Acute drug therapy
- 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.
- Published
- 2022
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