PERIANAL INFECTIOUS COMPLICATIONS IN PATIENTS WITH GRANULOCYTOPENIA AND HAEMATOLOGICAL MALIGNANCIES

Abstract

AIM : to study the perianal infection (PI) in patients with granulocytopaenia (GCP) and hematological malignancies (HM). PATIENTS AND METHODS: the prospective study (2016-1018) includes 95 episodes of PI in 76 patients with HM (male/female 35/44; mean age of 35 (17-69)). 43(54.4%) of the patients were detected to develop acute leukemia (AML – 34 (43%); ALL – 9(11.4%); NHL – 17(21.5%). The comparison of PI episodes within the GCP period (number of granulocytes less than 0.5x10 9 /l) and without it was done. RESULTS: PI episodes within the period of GCP were significantly much more often than those without GCP (77.9% vs 22.1%, relative risk 3.5 (95% CI: 2.4-5.2). The biggest number of PI episodes in the setting of GCP was registered within the period of chemotherapy (ChT): in the phase of consolidation (28.4%) and induction (13.3%) of acute leukemia ChT and lymphomas’ ChT (20.3%). Anal fissures were the most frequent source of PI within GCP period (66.2% vs 19.1% without GCP, p<0.001). Inflammatory changes in perianal tissues were clinical features of PI in the setting of GCP in 89.2% of the cases: inflammatory mass in 71.6% (vs 23.8% without GCP, p<0.001), abscess in 8.1% (vs 66.7% without GCP, p<0.001). In 10.8% of the cases of PI with GCP only perianal pain and fever were registered. No tissues change was detected with the lowest WBC count (Me 0.2 (0.1-0.5) x10 9 /l). Bloodstream infections were detected in 15 (20.3%) episodes within the period of GCP only, of them in 6 (8.1%) cases the species matching of microorganisms in blood and in rectum was noticed. Within the period of GCP antibacterial therapy was carried out in 98.6% of the cases: antibacterial therapy alone was applied in 87.8% of the episodes (vs 7.2% without GCP, p<0.001); both antibacterial therapy and surgical treatment were carried out in 10.8% (vs 61.9% without GCP, p<0.001) of the cases. Mean duration of antibiotic treatment of patients with GCP was drastically longer in the group of postoperative patients in comparison with the group of those who had conservative treatment (25.5 vs 15.1 days, p=0.05). Antimicrobial therapy within GCP period resulted into inflammation regress in 83.1% of the cases; abscess or fistula formation, hence surgical treatment in 13.8% of the cases; progression of infection in 3.1% of the cases. Increase of GCP duration up to 30 and more days is connected with bacteremia rate increase (12.5% vs 28%, p<0.05); combinations of PI with other infections (25% vs 52%, p<0.05); requirement of antimicrobial therapy modification (16.7% vs 40%, p<0.05). CONCLUSION: GCP significantly raises risk of PI. PI that develops in the setting of GCP, is characterized by abnormal, often low clinical manifestations and high risk of sepsis. Invasion of microorganisms through affected tissue seals is the basic mechanism of perianalinfection within the period of GCP. Antibacterial therapy is the prior method of PI treatment in the settings of GCP; antibacterial therapy efficiency is 83.1%. Need for surgery in the period of GCP is associated with the infectious episode and antibacterial therapy duration increase. Lengthening of GCP is a negative predictor in PI treatment.