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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0045-1801885
Original Article

Evaluating the Effects of Colonization with Multidrug-Resistant Bacteria on the Outcomes of Induction Chemotherapy in Patients with Acute Leukemia: A Prospective Analysis

Perraju Bhaskar Bhuvan Lagudu
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Varalakshmi Vijaykumar
2   Microbiology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Mounica Chekuri
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Devleena Gangopadhyay
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Jayachandran Perumal Kalaiyarasi 
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Prasanth Ganesan 
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Swaminathan Rajaraman
3   Biostatistics, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
,
Venkatraman Radhakrishnan 
1   Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu India
› Author Affiliations
Funding None.
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Abstract

Introduction The presence of multi-drug resistant (MDR) bacteria has been linked to higher rates of morbidity and mortality in patients with acute leukemia.

Objective This prospective study aimed to evaluate the prevalence of MDR bacteria in stool samples of patients undergoing induction chemotherapy for acute leukemia and to explore its association with clinical outcomes.

Materials and Methods The study recruited 200 patients, aged 1-60 years, with newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) who were scheduled to receive intensive induction chemotherapy. Stool samples were obtained on days 1 and 15 of the induction phase, and standard bacterial culture methods were used to determine culture and sensitivity.

Results Two hundred patients were enrolled from January 2018 to March 2020. On day 1, 35.7% of the stool cultures were positive, with all identified bacteria being MDR. On day 15, 36.7% of the samples were positive for MDR bacteria. MDR E. coli and MDR Enterococcus faecium were the most common organisms isolated in the stool culture. The detection of MDR bacteria in day 15 stool cultures was significantly associated with an increased risk of infections, admissions to the intensive care unit, mortality, and failure to achieve remission.

Conclusion These findings indicate that monitoring stool colonization with MDR bacteria during induction chemotherapy could be crucial for identifying patients at elevated risk of adverse outcomes and optimizing antimicrobial strategies.

Keywords

infection - acute leukemia - multidrug resistant - chemotherapy - stool culture

Authors' Contributions

Data collection was performed by M.C., V.R., V.V., P.B.B.L., D.G., J.P.K., and P.G. The data analysis was performed by V.R. and S.R. The management of patients in the trial was handled by V.R., D.G., P.B.B.L., J.P.K., and P.G.


Data Availability Statement

The data cannot be shared due to patient privacy and ethical issues.


Presentation

This article was presented as an oral presentation at the SIOP 2023 Annual Meeting and poster presentation at the MASCC 2023 Annual Meeting.




Publication History

Article published online:
10 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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