Pattern of Infectious Morbidity During Post-Remission High-Dose Cytarabine Consolidation in Acute Myeloid Leukemia

High-dose cytarabine (HiDAC) is an established post-remission consolidation therapy for acute myeloid leukemia (AML), but infectious morbidity remains an important treatment-related concern. Data describing infectious complications during HiDAC consolidation in the Bangladeshi setting are limited. This study evaluated the pattern of infectious morbidity and microbiologically documented bacterial infections following HiDAC consolidation in adults with AML. This hospital-based cross-sectional observational study was conducted in the Department of Hematology, Chittagong Medical College Hospital, from January to December 2018. A total of 50 adults with AML who achieved remission following standard 3+7 induction therapy and subsequently received HiDAC consolidation were included by purposive sampling. HiDAC was administered at 3 g/m² twice daily on days 1, 3 and 5 for three planned cycles. Clinical manifestations of infection and microbiological findings were recorded during follow-up. Data were analysed using SPSS version 23. Results: Among 50 patients, 56.0% were male; male-to-female ratio, 1.27:1; Mean age ± standard deviation (SD) was 29.18 ± 8.583 years; 52.0% were aged 18-30 years and 76.0% were from rural areas. Pallor was present in 98.0% of patients. The most frequent infectious manifestations were unexplained fever (32.0%), mucositis in 28.0%, sore throat in 26.0%, diarrhoea in 18.0%, and pneumonia in 16.0%. Across successive cycles, the frequency of sore throat declined from 40.9% (9/22) in cycle 1 to 18.8% (3/16) and 8.3% (1/12) in cycles 2 and 3, respectively; unexplained fever declined from 40.9% (9/22) to 25.0% (4/16) and remained 25.0% (3/12). Mucositis decreased from 36.4% (8/22) to 18.8% (3/16) before increasing to 25.0% (3/12). Bacteremia occurred in 9/50 (18.0%) patients, with Gram-positive organisms accounting for 7/9 (77.8%) isolates; Staphylococcus epidermidis was the most frequent bloodstream isolate. Non-bacteremic microbiologically documented infection occurred in 10/50 (20.0%), predominantly due to Gram-negative organisms (6/10, 60.0%), with Escherichia coli being the most frequent isolate. Infectious morbidity was common during HiDAC consolidation, with mucosal, respiratory, gastrointestinal, and febrile manifestations predominating. Bacteremia and other microbiologically documented infections occurred in a substantial proportion of patients, supporting close clinical monitoring and timely microbiological evaluation throughout consolidation therapy. Bangladesh Med J. 2026 Jan; 55(1): 48-56