Science and pragmatism in the treatment and prevention of neutropenic infection

Service de Médecine Interne et Laboratoire d'Investigation Clinique H. Tagnon, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.31). 07/1998; 41 Suppl D(suppl 4):13-24. DOI: 10.1093/jac/41.suppl_4.13
Source: PubMed


The following aspects of the management of patients with granulocytopenia and fever are reviewed in this article: adaptation of initial antibiotic regimens to the recent changes in the most common causative pathogens (namely a change from Gram-negative bacteria to Gram-positive bacteria and fungi); subsequent modifications of the empirically administered treatments; improvement of the host's defence by reducing the duration of neutropenia; and indications for out patient therapy of febrile episodes.

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    • "Hospitalization invariably results in replacement of indigenous microbes by similar microbes with increased antibiotic resistance (John et al, 2000). Changes in the types of pathogens isolated in severe infection might also affect resistance species inherently differing in antimicrobial susceptibility (Klastersky, 1998). E. coli, S. aureus, Pseudomonas, Proteus, Streptococcus are the most abundant organism responsible for the nosocomial and community acquired infection (Pfaller et al, 1998) and the frequency of E. coli is high in nosocomial infections compared with community acquired infections (Bert et al, 2003; Erdinc et al., 2006). "
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    ABSTRACT: Prevalence of microorganisms was studies in clinical samples of various body fluids (n=12,259), collected from patients at Post graduate Medical Institute Hayatabad Medical Complex (PGMI, HMC) Peshawar. Only 34.90% of samples exhibited growth, 36.25% of these isolates were Gram positive and 63.75% were Gram negative bacteria. E. coli was the most prevalent organism (39.45%) followed by S. aureus (32.23%), Proteus spp. (9.23%), Pseudomonas spp. (6.54%), Streptococuss spp. (3.51%), Acinetobacter spp. (2.66%), Citrobacter spp. (2.8%), Providencia spp. (2.2%) and miscellaneous bacteria (1.38%). The growth of bacteria was high in pus samples (44.03%) followed by urine (38.21%), high vaginal swab (HVS) (8.58%), cerebrospinal fluid (CSF) (1.96%), blood (3.39%) and miscellaneous samples (3.83%). E. coli and S. aureus were the most prevalent organism in urine (56.57%) and pus samples (44.02%), respectively. The frequency of E. coli (61.76%) was high in samples collected from female patients and percentage of the infections caused by the S. aureus in male and female patients was 47.9 and 52.1, respectively. During the study period, frequency of the E. coli was high during April to October and the prevalence of S. aureus was very common during March to October. Consistent but insignificant increase in the beta-lactamase producing S. aureus and E. coli was observed throughout the period of the study. However, increase in the beta-lactamase producing S. aureus and E. coli was above 80%. The prevalence of extended spectrum beta-lactamase (ESBL) in E. coli was increased from 13.85% in year 2000 to 22.66% in year 2003. The increasing in prevalence of microorganism, particularly of beta-lactamase producing E. coli and S. aureus and ESLB is alarming situation. Various measured like prescribing and patient compliance are required to control the increase in the prevalence of microorganism.
    Preview · Article · Nov 2008 · Pakistan journal of pharmaceutical sciences
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    • "Although the percentage of deaths attributable to infection has fallen considerably from 70 Á/80% recorded in the 1960s and 1970s, a study of trials published by the EORTC-IATCG from 1978 to 1994 revealed that among nearly 800 documented bacteraemias observed in 8 therapeutic trials (I Á/V, VIII, IX and XI), the overall mortality rate decreased from 21% to 7% [3] [54]. Recent IATCG-EORTC trials show that the overall mortality ranges between 5% and 12% with an infectious mortality rate between 1% and 3% [5] [7] [11]. Our data were compatible with these reports with an overall mortality rate of 7% and an infectious related mortality of 2.1%. "
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    ABSTRACT: The urgent need to treat presumptive bacterial or fungal infections in neutropenic patients has meant that initial therapy is empiric and based on the pathogens most likely to be responsible, and drug resistance. The traditional empirical treatment in Norway has been penicillin G and an aminoglycoside, and this combination has been criticized over recent y. We wished to analyse the microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in febrile neutropenic patients. This was a prospective multicentre study. During the study period of 2 y, a total of 282 episodes of fever involving 243 neutropenic patients was observed. In 34% of episodes bacteraemia was documented. Overall, 40% of the episodes were caused by Gram-positive organisms, 41% by Gram-negative organisms and 19% were polymicrobial. The most frequently isolated bacteria were Escherichia coli (25.6%), a- and non-haemolytic streptococci (15.6%), coagulase-negative staphylococci (12.4%) and Klebsiella spp. (7.4%). None of the Gram-negative isolates was resistant to gentamicin, meropenem, ceftazidime or ciprofloxacin. Only 5 coagulase-negative staphylococci isolates were resistant to both penicillin G and aminoglycoside. The overall mortality rate was 7%, and 1.2% due to confirmed bacteraemic infection.
    Full-text · Article · Feb 2005 · Infectious Diseases
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    • "Combination therapy has long been considered to be a possible strategy for minimizing antifungal resistance, by extrapolating from observations made in the therapy of bacterial infections. Resistance and tolerance (lack of cidal activity) have been cited as the bases for recommending combination antibacterial therapy, especially for bloodstream infections caused by Gram-negative bacilli and Enterococcus species (Klastersky, 1998). However, antifungal resistance and tolerance are a weaker rationale for the empirical use of combination antifungal therapy. "
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    ABSTRACT: The availability of new antifungal agents with unique mechanisms of action and improved tolerability has widened the possibilities for the use of combination antifungal therapy for difficult-to-treat opportunistic mycoses. However, the use of this therapy is largely governed by empiricism, especially in patients with invasive mould infections, for whom there is a tremendous need to improve outcomes. Because of the difficulties associated with the design and conduct of clinical trials of combination antifungal therapy for opportunistic mycoses, the majority of the studies evaluating antifungal combinations are still performed in the laboratory or using animal models of infection. However, the methods used to assess combined antifungal effects in vitro and in animals are poorly standardized, and there is little evidence that data generated from these studies can be translated in treating human mycotic infections. Despite the empiricism of combination antifungal therapy, certain principles help guide the use and study of these regimens.
    Full-text · Article · Aug 2004 · British Journal of Haematology
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