Background: Infection is a major complication in aplastic anemia (AA) patients. Primary objectives of this study\nwere to determine the prevalence of infections and to determine types of pathogens associated with infections in\npatients with AA. Secondary objectives were to evaluate overall survival after infections as well as risk factors of\ninfections in patients with AA.\nMethods: The authors retrospectively evaluated the infectious episodes (IEs), type of infections, associated pathogens,\nand outcomes of infections in patients with AA who were diagnosed and treated at Chiang Mai University between\nJanuary 2010 and December 2015.\nResults: Sixty-seven patients with a median age of 51 years (range, 15â??87 years) were enrolled. Forty two patients\n(62.6%) were severe AA. Median absolute neutrophil count (ANC) was 984 /mm3 (range, 120â??5500/mm3). Twenty\nfive patients (37.3%) received antithymocyte globulin plus cyclosporine A, 41 patients (61.1%) received anabolic\nhormone, and 2 patients (2.9%) underwent allogeneic hematopoietic stem cell transplantation. Overall, 31 IEs\nwere documented in 22 patients (32.8%). The most common microbiologically documented site of infection was\nbloodstream infection (23.4%) followed by pulmonary infection (14.9%). Culture-negative febrile neutropenia\noccurred in 12.7%. Common pathogens identified were bacteria (73.9%), mainly gram-negative (52.9%) including\nAcinetobacter baumannii (23.5%) and Pseudomonas aeruginosa (17.6%). Fungal infections were diagnosed in 21.7%\nand all were Aspergillus spp. Six patients (9%) died during the study period. All of them died from infection which\ngram-negative bacteria were most common pathogens (66.7%). Patients with infections had 5-year overall\nsurvival of 72% that is significantly less than patients without infection (100%) (p = 0.0002). Only risk factor that\ncorrelates with high probability of infection was ANC < 500/mm3. (HR 2.29, 95%CI 1.03â??7.72, p = 0.043).\nConclusions: Prevalence of infections in AA patients in Chiang Mai University was 32.8% Bacterial infections especially\ngram-negative bacteria were the major pathogens. Patients with ANC < 500/mm3 had higher risk of infections. Infection\nwas the most important cause of death in AA.
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