Continuous Infusion Antibiotic Therapy for Neutropenic Patients

Bodey, Gerald P.

doi:10.1007/978-94-009-3193-0_42

Cited by 2 publications

(3 citation statements)

References 48 publications

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“…Two-thirds of the patients who developed an infection, irrespective of its locus, had two or more comorbid conditions diagnosed on admission. Twelve patients had none (7) or one (5) associated comorbid condition. Of all the major comorbid condition categories reported on admission, the most commonly reported from patients with infections had metabolic [17/ tients with skin infections, all were diagnosed with diabetes mellitus.…”

Section: Resultsmentioning

confidence: 99%

“…[4][5][6] Principles of antibiotic therapy in neutropenic cancer patients undergoing chemotherapy have evolved over the past 30 years, largely from studies involving patients presenting with hematological malignancy. 7 Studies on palliative patients with solid tumors and the patterns of infection and antibiotic use are minimal. [8][9][10][11][12][13][14][15] In this descriptive retrospective study, we have assessed the site-specific frequencies of infection, the pattern of antibiotic use, symptom response to antibiotic therapy, and the possible relationship between patient symptom profiles and subsequent infection.…”

Section: Introductionmentioning

confidence: 99%

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Bacterial Infections in Terminally Ill Hospice Patients

Vitetta

Kenner

Sali

2000

Journal of Pain and Symptom Management

108

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Terminally ill patients are very susceptible to infections, which are the result of disease-related processes and/or therapy-induced mechanisms. These patients are already subject to multiple severe symptoms and associated comorbid conditions, with much resultant distress. Infection increases this symptom burden and further reduces quality of life. We have retrospectively investigated the prevalence of infection and clinical course in 102 consecutive patients who died after admission to a tertiary palliative care unit and assessed the site-specific frequency of infection, pathogenic organisms involved, and the pattern of antibiotic agents used. The prevalence of symptoms and comorbid conditions on admission and during the progress phase of care were noted. Median overall survival of the total cohort was 12 days. The median survival of patients with infections was 22 days. Thirty-seven patients (36.3%) were diagnosed with 42 separate infections. The sites of infections were the urinary tract (42.5%), the respiratory tract (22.9%), blood (12.5%), skin and subcutaneous tissues (12.5%), and the eyes (10.0%). There were 20 separate positive cultures isolated from specimens obtained from 13 individual patients. Three isolates were obtained from 1 patient, 2 isolates obtained from 5 patients, and 1 isolate was obtained from each of the 7 remaining patients. Escherichia coli was the most common pathogen isolated. Eleven patients with infections (31.4%) were diagnosed on admission, and antibiotic treatment was commenced within 48 hours of admission in 21 patients (60%). Overall antibiotic response and symptom control of infections was observed to be a minimum of 40%. Psychological distress was common in this group of patients (P = 0.001) as were disabling symptoms on admission, such as pain, immobility, and weakness. Symptoms indicating poor survival, such as severe pain and dyspnea, were not significantly associated with infection. Decreased patient survival in this cohort was not significantly associated with the presence of bacterial infection (P = 0.07), irrespective of whether or not a positive culture isolate was obtained. We conclude that appropriate management of infection resulted in enhanced palliative symptom control.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial Infections in Terminally Ill Hospice Patients

Vitetta

Kenner

Sali

2000

Journal of Pain and Symptom Management

108

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“…Algorithmic approaches to treat FN have been developed based on clinical parameters. Standard approach to treatment included obtaining specimens to identify focus of infection and begin empiric antimicrobial therapy based on local microbiological data, as delay in initiating treatment is associated with worse outcome 7 . Although used frequently, role of colony stimulating factors, in primary and or secondary settings is controversial 2 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Incidence and Impact of Baseline Electrolyte Abnormalities in Patients Admitted with Chemotherapy Induced Febrile Neutropenia

Shaikh¹,

Bawany²,

Masood³

et al. 2011

J. Cancer

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BACKGROUND: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature.METHODS: This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0.RESULTS: Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalitiesCONCLUSION: This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.

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Continuous Infusion Antibiotic Therapy for Neutropenic Patients

Cited by 2 publications

References 48 publications

Bacterial Infections in Terminally Ill Hospice Patients

Bacterial Infections in Terminally Ill Hospice Patients

Incidence and Impact of Baseline Electrolyte Abnormalities in Patients Admitted with Chemotherapy Induced Febrile Neutropenia

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