Patient Information Form
Basic patient information
Age (14-80):
Sex:
Male
Female
Disease:
AML
ALL
AMPL
Others
Tumor stage-consolidation:
no
yes
Comorbidities
Chronic liver disease:
no
yes
Chronic renal disease:
no
yes
Diabetes mellitus:
no
yes
Sources of infection
Primary BSI:
no
yes
Pulmonary source of infection:
no
yes
Perianal infection:
no
yes
Oral infection:
no
yes
Urinary tract infection:
no
yes
Skin and soft tissues infection:
no
yes
Intra-abdominal infection:
no
yes
Central venous catheter infection:
no
yes
Clinical complications
Shock:
no
yes
Hypoproteinemia:
no
yes
Profound neutropenia:
no
yes
Duration of neutropenia (0-100):
Treatment
Chemotherapy:
no
yes
HSCT:
no
yes
Immunosuppressive therapy:
no
yes
Previously exposed to antibiotic:
no
yes
Previously exposed to cephalosporin:
no
yes
Previously exposed to TZP:
no
yes
Previously exposed to carbapenem:
no
yes
Previously exposed to FQ:
no
yes
Previous CRE colonization:
no
yes
Pathogen
Pathogen:
Escherichia coli
Klebsiella pneumoniae
Enterobacter cloacae
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