Abstract
BackgroundPerianal infection is a common problem for patients with acute leukemia. However, neutropenia and bleeding tendency are relatively contraindicated to surgical intervention. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are also rarely discussed.MethodThe medical records of 1102 adult patients with acute leukemia at a tertiary medical center in Taiwan between 2001 and 2010 were retrospectively reviewed and analyzed.ResultThe prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia. Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections. Patients with acute myeloid leukemia had higher recurrent rates than acute lymphoblastic leukemia patients (p = 0.028). More than half (n = 61, 53%) of the perianal infections were caused by gram-negative bacilli, followed by gram-positive cocci (n = 36, 31%), anaerobes (n = 18, 15%) and Candida (n = 1, 1%) from pus culture. Eighteen patients experienced bacteremia (n = 24) or candidemia (n = 1). Overall 41 (68%) of 60 patients had polymicrobial infection. Escherichia coli (25%) was the most common micro-organism isolated, followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), and Bacteroides species (11%). Twenty-five (34%) of 74 patients received surgical intervention. Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067). Four (5%) patients died within 30 days after diagnosis of perianal infection. Univariate analysis of 30-day survival revealed the elderly (≧ 65 years) (p = 0.015) and patients with shock (p<0.001) had worse outcome. Multivariate analysis showed septic shock to be the independent predictive factor of 30-day crude mortality of perianal infections (p = 0.016).ConclusionPerianal infections were common and had high recurrence rate in adult patients with acute leukemia. Empirical broad-spectrum antibiotics with anaerobic coverage should be considered. Shock independently predicted 30-day crude mortality. Surgical intervention for perianal infection remains challenging in patients with acute leukemia.
Highlights
Perianal abscess and anal fistulas are the acute and chronic manifestations of perianal infection [1,2,3]
Surgical intervention for perianal infection remains challenging in patients with acute leukemia
Disease manifestations and outcomes of perianal infection in modern care, we retrospectively reviewed the medical records of 1102 acute leukemic patients in the National Taiwan University Hospital (NTUH) between 2001 and 2010 and analyze the clinical characteristic, microbiology and outcomes of perianal infection in acute leukemic adult patients
Summary
Perianal abscess and anal fistulas are the acute and chronic manifestations of perianal infection [1,2,3] It is estimated one-third of patients with perianal abscess may be complicate by chronic anal fistula formation [2,3]. Infection is one of the most serious complications in patients with acute leukemia receiving chemotherapy [6,7]. The Disease spectrum of perianal infection might range from mild local cellulitis to life-threatening sepsis in patients with chemotherapy related neutropenia. Can perianal infection cause mortality, but anal pain and discomfort significantly impact the quality of life in patients with acute leukemia [14]. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are rarely discussed
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