Bone and Joint Infections in Acute Myelogenous Leukemia: A Retrospective Review of Patients at Mayo Clinic

Abstract

Background. Patients with hematologic malignancies are at higher risk for infections, and current literature on bone and joint infections (BJI) in acute myelogenous leukemia (AML) is limited to case reports. This study aimed to identify frequency and characteristics of BJI in AML. Methods. We retrospectively reviewed 1118 patients in the AML database at Mayo Clinic from 1 January 2005 through 1 January 2015. A computerized search of the electronic medical record utilizing diagnosis codes, pathology reports, and free text searches, followed by manual chart review, identified 18 unique patients with BJI as depicted in the figure. Results. Of the 18 patients, septic arthritis (7/18, 39%) occurred most frequently. Sixteen of 18 (89%) were male, and median age was 69 years old (range 23-77). Twelve of 18 (67%) were in remission from AML while 6/18 (33%) were neutropenic at the time of BJI, and 5/18 (28%) occurred after transplant. Pathogens were primarily Gram-positive organisms (12/18, 67%), and 6/18 (33%) had no pathogen isolated. All patients received culture-guided induction antimicrobial therapy, and 9/18 (50%) had surgical intervention. Treatment and outcome by infection can be seen in the figure. Of the 5 (28%) treatment failures (TF), 2 (40%) had vertebral osteomyelitis while 2 (40%) had prosthetic joint infection (PJI), and 1 (20%) had septic arthritis. None had prior transplants, and 2/5 (40%) were in remission from AML. Median time from diagnosis of BJI to TF was 3.4 months (range 1.8-37.6). 11/18 (61%) were alive one year after BJI, and at latest follow-up, 4/18 (22%) were alive, all of whom had BJI treated successfully. Median overall survival from diagnosis of BJI was 17.4 months (range. Conclusion. BJI are uncommon in AML, and pathogens are similar to patients without AML. TF can occur at a high rate, particularly in vertebral osteomyelitis and PJI. However, TF may not necessarily correlate with hematologic status or overall survival. AML, acute myelogenous leukemia; BJI, bone and joint infection; I&D, irrigation and debridement; Abx, antibiotic therapy alone; TF, treatment failure; MI, myocardial infarction (Figure Presented) .