Comparative analysis of infectious complications with outpatient vs. inpatient care for adults with high-risk myeloid neoplasm receiving intensive induction chemotherapy

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.

Keywords:

• Infectious complications
• acute myeloid leukemia
• early hospital discharge
• myeloid leukemias and dysplasias

Disclosure statement

G.A.H. and V.L.W.: employment and equity ownership (Pfizer). The other authors declare no competing financial interest.

Additional information

Funding

Research reported in this publication was supported by a Sponsored Research Agreement with Pfizer, Inc. Hyperlink reference not valid.. and a Department of Medicine/University of Washington Quality and Safety Accelerator Grant (both to R.B.W.).