2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.

St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 04/2002; 34(6):730-51. DOI: 10.1086/339215
Source: PubMed
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    ABSTRACT: Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N. We used Lean-Methodology and a Plan-Do-Study-Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub-process times, and clinical outcomes. Our QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60 min nearly 100% of the time. All TTA sub-process times also improved. Moreover, achieving TTA <60 min significantly reduced the need for ICU consultation or admission (P = 0.003) in this population. Here we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60 min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N. Pediatr Blood Cancer © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc. © 2015 The Authors. Pediatric Blood & Cancer Published by Wiley Periodicals, Inc.
    Pediatric Blood & Cancer 02/2015; 62(5). DOI:10.1002/pbc.25435 · 2.56 Impact Factor
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    ABSTRACT: Lung cancer (LCa) is one of the most common and deadly malignancies in elderly patients. During the course of the disease, these patients frequently present with lower respiratory tract infection. Therefore, this study aims to investigate the clinical features of lower respiratory tract infection in elderly LCa patients and evaluate the impact on overall survival rate. Clinical and laboratory data were analyzed retrospectively for a total of 1936 patients that were over 60-years-old. Patients were classified into three groups based on pulmonary diseases: Group 1, lung cancer (LCa); Group 2, chronic obstructive pulmonary disease (COPD); and Group 3, other medical diseases without pulmonary problems (OMD). Univariate and multivariate analysis were used to evaluate related risk factors of infections and prognostic factors. The infection rate of the LCa group (46.25%) was significantly higher than the COPD (31.40%) and OMD (23.33%) groups. Polymicrobial infections were most prevalent in the LCa group (28.75%), which far exceeded the prevalence in COPD (11.05%) and OMD (4.44%) groups. In LCa patients, the most frequent pathogens were Gram-negative bacteria (44.87%), followed by fungi (34.62%) and Gram-positive bacteria (20.51%), the major pattern of polymicrobial infections was mixed Gram-negative bacteria and fungi (43.48%). Multivariate analysis revealed that COPD, pleural effusion, anatomical type, low cellular immune function, and length of hospital stay were related risk factors of lower respiratory tract infection in elderly LCa patients. A multivariate Cox proportional hazards regression model revealed that age, stage of TNM, surgical resection, antitumor therapy, lower respiratory tract infection, COPD, and pleural effusion were independent prognostic factors for cancer-related death. Patients who received effective antimicrobial treatment had a better outcome than those who did not respond to antimicrobial drugs (HR = 0.458, P < 0.05). Understanding lower respiratory tract infection in elderly LCa patients is vital if we are to set up corresponding measures and to target effective antimicrobial treatment.
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    ABSTRACT: Cefozopran is a parenteral cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria. The objective of this study was to evaluate the pharmacokinetics of cefozopran after single- and multiple-dose intravenous administration in healthy subjects, to provide clinical guidance in its application. This was a single-center, open-label, randomized, two-phase study conducted in 12 subjects. In the single-dose phase, subjects were randomly assigned to receive single doses of 0.5, 1.0 and 2.0 g of injected cefozopran hydrochloride in a three-way crossover design with a 5-day washout period between administrations. In the multiple-dose phase, subjects received 2.0 g every 12 h for 4 days. Plasma and urine pharmacokinetic samples were assayed by a validated high-performance liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were calculated and analyzed statistically. Safety assessments were conducted throughout the study. Twelve healthy volunteers (six males and six females) were enrolled and completed the study. Following a single 1-h intravenous infusion of 0.5, 1.0 or 2.0 g cefozopran, maximum plasma concentration (C max) and area under the plasma concentration-time curve from time zero to the time of the last measurable concentration (AUClast) increased in a dose-proportional manner. The mean half-life in plasma (t ½) was in the range of 1.20-2.80 h. Cefozopran was mainly excreted in its unchanged form, with no tendency for accumulation, via the kidney, and varied from 65.99 to 73.33 %. No appreciable accumulation of either drug occurred with multiple intravenous doses of cefozopran, and pharmacokinetic parameters for cefozopran were similar on days 1 and 4. No serious adverse events were reported. Adverse events were generally mild. Cefozopran was safe and well tolerated in the volunteers and displayed linear increases in the C max and AUClast values.
    Drugs in R & D 02/2015; 15(1). DOI:10.1007/s40268-014-0075-3 · 1.71 Impact Factor

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