Publications (14)62.39 Total impact
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Article: Palatal mucormycosis in patients with hematologic malignancy and stem cell transplantation.
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ABSTRACT: We present two patients with acute myelogenous leukemia who developed palatal mucormycosis, as well as a review of 15 well described reported cases of the same condition in patients who had hematologic malignancy and had undergone hematopoietic stem cell transplantation. Early diagnosis of palatal mucormycosis requires high suspicion of the disease along with a thorough oral examination. Mucormycosis is a devastating disease with a high mortality rate, thereby stressing the importance for early appropriate antifungal therapy in immunocompromised patients with palatal lesions while awaiting the results of histopathology and cultures.Medical mycology: official publication of the International Society for Human and Animal Mycology 11/2010; 49(4):400-5. · 2.13 Impact Factor -
Article: Current microbiology of surgical site infections associated with breast cancer surgery
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ABSTRACT: B reast cancer is one of the most frequent malignancies in women worldwide. Excision of the primary tumor (by mastectomy or breast-conserving surgery) and sentinel lymph node or axillary lymph node dissection are standard procedures for the treatment of most cases. 1 In the United States, approximately 200,000 breast cancer surgical procedures are performed annually. The frequency of infection following such procedures is estimated to be between 4% and 8%, which translates to an annual figure of 8000 to 16,000 cases. 2 Episodes of infections are associated with consider-able morbidity and increased healthcare costs. 3 Infection prevention and prompt treatment using appropriate antimicrobial agents based on local microbiology and susceptibility/resistance patterns is desirable. Consequently, the authors decided to determine the current microbiology of infections associated with breast cancer surgery at the authors' institution, a National Cancer Institute (NCI) designated comprehensive cancer center. Materials and Methods The authors' institution is a 500-bed comprehensive cancer center devot-ed exclusively to the care of patients with cancer. All microbiological sam-ples are submitted to and processed by a central microbiology laboratory. A Abstract: Surgical site infections (SSI) are the most common complica-tions of breast cancer surgery. The authors identified 35 cases of SSI in the M.D. Anderson Cancer Center (Houston, TX) over a 7-month study period. Monomicrobial infections predominated (69%) with Staphylococcus aureus being isolated most often. A wide variety of gram-positive and gram-negative organisms were isolated from the 31% of polymicrobial infections, suggesting the need for broad-spec-trum coverage at least until culture results become available. Although all S aureus isolates were susceptible to vancomycin (minimal inhibito-ry concentration [MIC] ≤ 2.0 µg/mL), 63% of methicillin-susceptible isolates and 82% of methicillin-resistant isolates had MIC values of ≥ 1.0 µg/mL for this agent, indicating the need for alternative therapeu-tic agents. The organisms were susceptible to trimethoprim/sul-famethoxazole, rifampin, linezolid, daptomycin, and tigecycline.WOUNDS. 01/2010; 22:132-135. -
Article: Oral moxifloxacin for outpatient treatment of low-risk, febrile neutropenic patients.
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ABSTRACT: Low-risk febrile neutropenic patients can be treated without hospitalization with oral antibiotic regimens. Combination regimens are recommended. Our objective was to evaluate the feasibility of quinolone monotherapy (moxifloxacin) in this setting. In this open-label pilot study, eligible low-risk febrile neutropenic patients identified using pre-defined criteria (MASCC Risk Index) received oral moxifloxacin (400 mg) in our emergency center and were discharged after a 4-8 h observation period to ensure clinical stability. They subsequently received moxifloxacin 400 mg daily as outpatients. Success of monotherapy, outpatient management, the development of adverse events, and major medical complications were recorded. The trial was closed without reaching the target sample size of 40 patients due to slow accrual. Twenty-one evaluable patients were enrolled, with sarcoma and breast cancer being the predominant underlying neoplasms. Most patients (76%) were severely neutropenic (</=100 cells/mm(3)) on enrollment. There were 13 episodes (62%) of unexplained fever and eight documented infections including five episodes (24%) of bacteremia. The overall success rate of monotherapy was 95%. One patient with unexplained fever and persistent neutropenia required hospitalization and responded to alternative therapy. No significant toxicity or severe medical complications occurred. Oral outpatient quinolone monotherapy for low-risk febrile neutropenic patients appears feasible and needs to be formally evaluated in large randomized clinical trials.Supportive Care in Cancer 05/2009; 18(1):89-94. · 2.09 Impact Factor -
Article: Hospitalizations for infection in cancer patients: impact of an aging population.
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ABSTRACT: The aim of this study was to assess the impact of an aging US population on inpatient costs and resource utilization in cancer patients admitted for infection. From the Texas inpatient public use files (Texas Health Care Information Collection), which include all hospitals except federal institutions, we selected residents with cancer who also had a principal or admitting diagnosis of pneumonia, bacteremia/sepsis, or other documented infection in 2001. Selected admission records were directly adjusted by projected age-specific cancer prevalence totals for years 2006 and 2025 using surveillance epidemiology end results (SEER) and US census data. Charges were inflated to 2006 consumer price index for medical care then converted to costs using Texas Medicare cost-to-charge ratios. Over 9% of nearly 200,000 Texans admitted for infection in 2001 also had cancer. Projecting these results nationally, 318,000 discharges in cancer patients at a cost of $3.1 billion (B, 95% CI $2.8B, $3.4B) and 2.3 million (M) bed days would have been attributed to infections in 2006. By the year 2025, adjusting only for the aging population, costs could increase 45% to $4.5B (95% CI $4.1B, $4.9), with 27% more (3.4 M) hospital bed days occupied. Consequent to an aging population and the resulting increase in cancer prevalence, the healthcare burden of managing hospital admissions for infection in the vulnerable cancer population could be greatly magnified unless risk-based treatment and preventive strategies such as appropriate immunizations and infection control measures are implemented.Supportive Care in Cancer 12/2008; 17(5):547-54. · 2.09 Impact Factor -
Article: Disseminated salmonellosis in a patient treated with temozolomide.
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ABSTRACT: Temozolomide is a relatively new chemotherapeutic agent frequently associated with selective CD4+ T-lymphocytopenia. Patients with cell-mediated immune defects are at higher risk for acquiring infections with Salmonella species. We describe the first case of disseminated salmonellosis in a patient treated with temozolomide.The Journal of infection 09/2008; 57(5):414-5. · 4.13 Impact Factor -
Article: Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia.
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ABSTRACT: We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.Journal of Clinical Oncology 03/2008; 26(4):606-11. · 18.37 Impact Factor -
Article: Risk factors for infections with multidrug-resistant Stenotrophomonas maltophilia in patients with cancer.
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ABSTRACT: Stenotrophomonas maltophilia is responsible for an increasing number of infections, especially in hospitalized patients. Therapy options are limited and trimethoprim/sulfamethoxazole (TMP/SMX) is often the main treatment option for this infection. In the current study, the risk factors were determined for the emergence of multidrug-resistant (MDR) S. maltophilia. A case-control study was conducted to determine risk factors for the development of MDR S. maltophilia in cancer patients. The case group was composed of patients treated at the University of Texas M. D. Anderson Cancer Center for MDR S. maltophilia between 1996 and 2004 (n = 54). Two control groups were used: patients at comparable risk for S. maltophilia (C-controls) and patients with S. maltophilia infection that was susceptible to TMP-SMX and at least 2 other antibiotics (ciprofloxacin, ceftazidime, amikacin, and ticarcillin/clavulanate) (S-controls). When compared with C-controls, prior use of carbapenems or quinolones and admission to an intensive care unit within 30 days of isolation of the pathogen were found to be independently associated with MDR S. maltophilia infection (P < .02), as was an increased overall mortality rate (P = .04). When compared with S-controls, risk factors were history of S. maltophilia infection during the prior year and prior use of TMP-SMX (P = .015). Judicious use of TMP-SMX, carbapenems, and quinolones is necessary to control the risk for MDR S. maltophilia infection.Cancer 06/2007; 109(12):2615-22. · 4.77 Impact Factor -
Article: Medical and non-medical barriers to outpatient treatment of fever and neutropenia in children with cancer.
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ABSTRACT: A number of clinical trials have employed clinical criteria that can identify pediatric patients at low-risk for complicated episodes of fever and neutropenia (F&N) and have successfully treated low-risk patients in the outpatient setting. Despite this, inpatient management remains the standard of care. This trial tested the hypothesis that a strategy of initial hospitalization followed by continuation of therapy in the outpatient setting could be practically implemented in the majority of episodes. Patients presenting with F&N were initially evaluated to determine if they had high-risk clinical criteria that would exclude them from this approach. Eligible patients were then hospitalized and treated with iv antibiotics. On subsequent days the attending physician determined whether the patient had exhibited improvement and could continue therapy in the outpatient setting with oral antibiotics. Outpatients were seen three times weekly and continued antibiotics until recovery from F&N. Outpatient oral antibiotic therapy was practically implemented in less than one-quarter of episodes of pediatric F&N. Forty-nine percent of episodes were excluded from study by medical and social protocol exclusion criteria. One hundred five episodes were enrolled and among these 59 episodes included outpatient management. Common barriers to outpatient care included serious medical comorbidities, non-medical barriers including language and distance of residence from the medical center, and lack of interest. The average duration of outpatient care was 3.6 days following an average of 3.5 days of hospitalization. Ninety percent did not require rehospitalization. They experienced no complications. In only a minority of episodes can outpatient antibiotic management be implemented. Medical comorbidities and social barriers can make the transition to outpatient care difficult. However, initial hospitalization followed by oral antibiotic outpatient management appears safe and effective for low-risk patients who exhibit good responses to initial antibiotic therapy in hospital.Pediatric Blood & Cancer 03/2007; 48(3):273-7. · 1.89 Impact Factor -
Article: Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients.
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ABSTRACT: Stenotrophomonas maltophilia bacteremia is frequently found in cancer patients. This study attempted to determine how often the catheters were the source of this infection and the risk factors associated with catheter-related bacteremias. The microbiology records were retrospectively reviewed of all cancer patients having S. maltophilia bacteremia and indwelling central venous catheters seen between January 1998 and January 2004. In a multivariate analysis the patients' clinical characteristics, antimicrobial therapy, outcome, and source of bacteremia that were significantly associated with definite catheter-related S. maltophilia bacteremia as opposed to secondary bacteremia were identified. A total of 217 bacteremias were identified in 207 patients: 159 (73%) were primary catheter-related (53 definite, 89 probable, and 17 possible), 11 (5%) were primary noncatheter-related, and 47 (22%) were secondary. Multivariate analysis showed the following factors to be independently associated with definite catheter-related bacteremias: 1) polymicrobial bacteremia (odds ratio [OR], 7.6; 95% confidence interval [95% CI], 1.3-45.5); 2) no prior intensive care unit admission (OR, 0.06; 95% CI, 0.005-0.578); and 3) nonneutropenic status at onset (OR, 0.07; 95% CI, 0.013-0.419). The response rate to appropriate antibiotics and catheter removal was 95% in the patients with definite catheter-related bloodstream infections, compared with only 56% in the patients with secondary bacteremias (P = .001). The majority of the S. maltophilia bacteremias occurring in cancer patients with indwelling central venous catheters appear to be catheter-related and are often polymicrobial. Catheter-related S. maltophilia bacteremias occurred more frequently in noncritically ill, nonneutropenic patients, and prompt removal of the catheter was found to be associated with a better prognosis.Cancer 06/2006; 106(9):1967-73. · 4.77 Impact Factor -
Article: Risk factors for infections with multidrug-resistant Pseudomonas aeruginosa in patients with cancer.
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ABSTRACT: Pseudomonas aeruginosa is responsible for a wide range of infections. In immunocompromised patients with cancer, the emergence of multidrug resistant P. aeruginosa may have grave consequences. Patients with cancer who were infected with multidrug-resistant P. aeruginosa with polyclonal DNA restriction patterns were used as the case group. Two control groups were used: one group of cancer patients who were infected with multidrug-susceptible P. aeruginosa and another group of cancer patients who had the same underlying disease and the same intensive care unit exposure as patients in the case group but who were not infected or colonized by P. aeruginosa. Risk factors that were associated significantly with multidrug-resistant P. aeruginosa infection were the use of carbapenem for > or = 7 days, a history of P. aeruginosa infection during the preceding year, and a history of chronic obstructive pulmonary disease (P < 0.01). Carbapenems may need to be used more judiciously as first-line empirical therapy for cancer patients with prior pseudomonal infection or chronic obstructive pulmonary disease who require hospitalization, and alternative, antipseudomonal antibiotic regimens may need to be considered, especially in this patient population.Cancer 08/2005; 104(1):205-12. · 4.77 Impact Factor -
Article: Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients.
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ABSTRACT: We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode. Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature > or =38.0 degrees C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access. There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17-77) years, and 60% (n = 153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p < 0.002); Zubrod performance status > or =2 (p = 0.029); ANC <100/ml (p = 0.039), and age > or =70 years (p = 0.048). Outpatient treatment of low-risk febrile neutropenic cancer patients utilizing standard treatment pathways is associated with minimal morbidity and mortality and should be considered an acceptable standard of care with appropriate infrastructure available to provide strict and careful follow-up while on treatment. Certain factors are associated with higher risk of hospitalization and should be further examined in eligible patients with low-risk febrile neutropenia.Supportive Care Cancer 09/2004; 12(9):657-62. · 2.60 Impact Factor -
Article: Prospective, randomized study comparing quinupristin-dalfopristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections.
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ABSTRACT: Quinupristin-dalfopristin and linezolid have been shown to be efficacious in the treatment of vancomycin-resistant Enterococcus faecium (VREF) infections. However, the two antibiotics have not been compared in terms of safety and efficacy in a prospective randomized study. The objective of this study was to compare the safety and efficacy of the two drugs in the treatment of VREF infections in cancer patients. Forty cancer patients with VREF infection were randomized to receive linezolid 600 mg every 12 h or quinupristin-dalfopristin 7.5 mg/kg every 8 h. All patients were followed up for 30 days after discontinuation of study drugs. Linezolid and quinupristin-dalfopristin had comparable clinical responses (58% and 43%, respectively, P = 0.6). Myalgias and/or arthralgias occurred at a frequency of 33% in patients who received quinupristin-dalfopristin, but were not observed in the linezolid group (P = 0.03). In contrast, drug-related thrombocytopenia occurred in 11% of patients who received linezolid, but was not observed in the quinupristin-dalfopristin group (P = 0.2). In cancer patients, quinupristin-dalfopristin treatment is associated with a relatively high frequency of myalgias/arthralgias; however, profound thrombocytopenia might limit the choice of linezolid in a subpopulation of cancer patients.Journal of Antimicrobial Chemotherapy 05/2004; 53(4):646-9. · 5.07 Impact Factor -
Article: Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer.
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ABSTRACT: To investigate the epidemiology and environmental sources of Fusarium infections in patients with cancer. Retrospective case-control study conducted following surveillance environmental cultures and DNA analysis of isolated organisms. A tertiary-care, university cancer center. In 1996 and 1997, environmental cultures were performed on air samples and water systems. A retrospective chart review was performed for 70 patients with cancer identified with fusariosis between 1987 and 1997. Patients with fusariosis were compared with 49 uninfected control patients who occupied hospital rooms with positive environmental cultures for Fusarium. With the use of random amplification of polymorphic DNA, organisms isolated from infected patients were compared with environmental organisms. Most of the patients with Fusarium (40, 57%) were infected on or within 3 days of admission, indicating community rather than nosocomial acquisition. Patients were comparable in terms of underlying immunocompromised status to 49 uninfected control patients. However, the duration from admission to infection in the patients with fusariosis tended to be shorter than the duration from admission to discharge in the exposed control patients (P = .06). Water cultured from the hospital tanks and from sinks and water fountains was negative for Fusarium. With the use of polymerase chain reaction, environmental isolates did not match clinical ones. Quantitative air sampling showed that the quantitative outdoor Fusarium levels were eightfold higher than the indoor levels. During the rainy summer season, outdoor air concentrations of Fusarium were at their highest, coinciding with the peak incidence of fusariosis at our center. The most likely source of fusariosis was the external environment rather than nosocomial sources, such as water.Infection Control and Hospital Epidemiology 10/2002; 23(9):532-7. · 3.67 Impact Factor -
Article: Clinical pharmacology of timentin (ticarcillin and clavulanic acid)
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ABSTRACT: Ticarcillin (4 gm) and clavulanic acid (0.1 gm) were simultaneously administered as timentin to patients with cancer as therapy for infections. The pharmacokinetics of both ticarcillin and clavulanic acid were studied in 15 patients after 30-minute and 2-hour intravenous infusions. The mean (SD) ticarcillin plasma peak concentrations after the two infusions were 341 76 and 210 60 g/ml. The plasma terminal t½ values of ticarcillin were 80 32 and 56 12 minutes. The AUCs were 631 189 and 601 230 mg/L hr. The volumes of distribution of the area were 15 5 and 21 7 L and total clearances were 115 36 and 127 54 ml/min. The corresponding values for clavulanic acid after the infusions are as follows: mean peak concentrations, 5 1 and 4 1 g/ml; plasma terminal t½ values, 84 24 and 74 36 minutes; AUCs, 11 3 and 11 6 mg/L hr; volumes of distribution of the area, 22 3 and 32 6 L; and total clearances, 170 58 and 175 68 ml/min.Clinical Pharmacology & Therapeutics 07/1985; 38(2):134-139. · 6.04 Impact Factor
Top co-authors
Top Journals
Institutions
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2002–2009
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University of Texas MD Anderson Cancer Center
- Department of Biostatistics
Houston, TX, USA
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2005
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Shizuoka Cancer Center
Shizuoka-shi, Shizuoka-ken, Japan
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