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REVIEW ARTICLE

Bloodstream infections in patients with acute leukemia: A review

Raghad Alamri1 ,  Reem A. Almalhi2 ,  Abdulah O.S. Bawazeer3 ,  Fahad S. Alshehri3*
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1 Department of Medical Laboratory Science, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah , Saudi Arabia
2 Department of Clinical Laboratory Science, College of Applied Medical Sciences, King Saud University, Riyadh , Saudi Arabia
3 Division of Hematology and Microbiology, Pathology and Clinical Laboratory Medicine Administration Department, King Faisal Medical City for Southern Regions, Aseer Health Cluster, Abha , Saudi Arabia
EJMO, 026140156 https://doi.org/10.36922/EJMO026140156
Received: 2 April 2026 | Revised: 15 July 2026 | Accepted: 6 August 2026 | Published online: 7 September 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Acute leukemia (AL) is a life-threatening hematologic malignancy marked by the rapid expansion of immature blood cells and profound immune suppression. This immunocompromised state renders patients highly susceptible to bacterial infections, particularly bloodstream infections, which occur in 11% to 38% of cases and are a leading cause of morbidity and mortality.

Objective: This review provides an in-depth analysis of the bacterial infection burden in AL patients, focusing on common pathogens, risk factors, diagnostic hurdles, and clinical management.

Results: Gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci, and enterococci, along with Gram-negative pathogens like Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represent the most frequently isolated organisms. Both nosocomial and community-acquired infections are examined, with particular attention to the rise of multidrug-resistant strains. Risk factors for infection include prolonged neutropenia, chemotherapy, central venous catheters, and extended hospitalization. Diagnostic complexity arises from non-specific symptoms and delayed pathogen identification, making timely, accurate diagnosis critical. Advances in culture-independent testing and imaging are improving detection but remain underused. The cornerstone of effective management includes prompt empirical antibiotic therapy, targeted prophylaxis, and rigorous infection control. Adjunct strategies, such as vaccination and nutritional optimization, play supportive roles.

Conclusion: In conclusion, tackling infection-related complications in AL requires a multifaceted, proactive approach. Future priorities include developing unified diagnostic algorithms, enhancing antimicrobial stewardship, and tailoring interventions to individual risk profiles to improve survival and quality of life in this vulnerable population.

Keywords
Acute leukemia
Bloodstream infections
Neutropenia
Chemotherapy
Antimicrobial resistance
Im-munocompromised patients
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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