Estudio prospectivo y controlado, no aleatorizado, de tres cohortes sobre la efectividad de dos pautas antibióticas, levofloxacino y contrimoxazol, en profilaxis antibacteriana de pacientes neutropénicos

Escudero, Antonio Gracia; González, Myriam; Garrido, Francisco Giménez; Farré, Carlos Clavero; Pérez, Marta García; Corral, Gemma Álvarez; Bertos, Armando Reyes; Maldonado, Gracia Villegas; Cuartero, Antonio Rodríguez

doi:10.1016/s0025-7753(03)73691-4

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…[33][34][35][36][37][38] At a university hospital in Germany 2 attempts to discontinue prophylaxis were stopped because there were more bacteremia and deaths during the periods when prophylaxis was not given. 33,34 Discontinuation of prophylaxis in a Spanish and Swiss hospital 35,36 led to an increase in febrile episodes and bacteremia, but the differences did not reach statistical significance.…”

Section: Local Factors That May Affect Decisions Resistance To Fluoromentioning

confidence: 99%

“…37 In a third observational study from Spain, there was a tendency for reduced mortality in patients who received levofloxacin compared with patients who received either trimethoprimsulfamethoxazole or no prophylaxis. 38 Long-term surveillance for the development of ciprofloxacin resistance was conducted after a randomized controlled trial of antibiotic prophylaxis in hematologic patients. 39 After 10 years of continued prophylaxis with ciprofloxacin plus colistin, only 5 ciprofloxacin-resistant, gram-negative bacteria were isolated from 66 episodes of microbiologically documented infection among 47 patients during approximately 700 neutropenic episodes.…”

Section: Local Factors That May Affect Decisions Resistance To Fluoromentioning

confidence: 99%

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Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

174

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New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. For patients with acute leukemia or those who undergo bone marrow transplantation, prophylaxis with fluoroquinolones diminished the risk of death from any cause by 33% (95% confidence interval [95% CI], 2-54%). Thus, 55 patients who have acute leukemia or who undergo bone marrow transplantation must receive prophylaxis to prevent 1 death. In 4 studies that included patients with solid tumors or lymphoma, prophylaxis reduced the rate of death during the first month (relative risk, 0.51; 95% CI, 0.27-0.97), and 82 patients had to receive prophylaxis to prevent 1 death. The main argument brought against prophylaxis is the induction of resistance. Patients who received prophylaxis did not experience more infections caused by resistant strains than patients in the control group. The recent GIMEMA study was con- N ew evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. A systematic review and meta-analysis of randomized controlled trials 1 demonstrated that death from all causes was reduced by 34% (95% confidence interval [95% CI], 21-45%) in neutropenic patients who received any antibiotic prophylaxis and by 40% (95% CI, 17-56%) in patients who received quinolones for prophylaxis. in addition, the occurrence of febrile episodes and bacterial infections decreased significantly (Table 1). Most of the studies that were included in that meta-analysis addressed patients with hematologic malignancies. In the most recent and largest randomized controlled trial that included patients in whom neutropenia was expected to occur for more than 7 days (mainly with acute leukemia and autologous peripheral blood stem cell transplantation), 2 patients who received levofloxacin as prophylaxis had a relative risk (RR) of 0.54 (95% CI, 0.25-1.16) for mortality compared with the placebo group: a Dr. Cullen has received honoraria from Sanofi Aventis.We thank Dr. Vivianne Tjan-Heijnen and Ms. Muriel Debois for supplying us with full data regarding mortality from their study.

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Section: Local Factors That May Affect Decisions Resistance To Fluoromentioning

confidence: 99%

Section: Local Factors That May Affect Decisions Resistance To Fluoromentioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

174

View full text Add to dashboard Cite

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Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression—a randomized pilot study during COVID-19

Gomà,

Arias-Pujol,

Prims

et al. 2023

Arch Womens Ment Health

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Early interventions may promote reductions in mothers’ anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers’ symptomatology was assessed, as well as the baby’s development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies’ development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers’ depressive-anxiety symptomatology.

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Fluoroquinolone resistance of Escherichia coli at a cancer center: epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia

Kern

Klose

Jellen-Ritter

et al. 2005

Eur J Clin Microbiol Infect Dis

132

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The aim of the present study was to investigate the epidemiologic evolution of fluoroquinolone resistance of E. coli clinical isolates from patients admitted to a hematology-oncology service where fluoroquinolone prophylaxis during neutropenia was recommended as the standard of care for many years but was then discontinued in a trial conducted in patients with acute leukemia. Fluoroquinolones had been shown to decrease the incidence of gram-negative bacteremia in cancer patients with neutropenia, yet it was thought that the emergence of resistance in Escherichia coli and other gram-negative bacteria may have caused a progressive lack of efficacy of fluoroquinolone prophylaxis. Epidemiologic surveillance of fluoroquinolone resistance of E. coli clinical isolates at our cancer center since 1992 showed a continuing influx of new clones not previously observed in the population of cancer patients, an increase in the number of cancer patients per year colonized and/or infected by fluoroquinolone-resistant E. coli (1992-1994, 10-16 patients; 1995-1997, 24-27 patients), and a resistance rate of >50% among E. coli bloodstream isolates of hematology-oncology patients. A 6-month fluoroquinolone prophylaxis discontinuation intervention trial in 1998 suggested that despite increasing resistance among E. coli isolates, fluoroquinolone prophylaxis in acute leukemia patients was still effective in the prevention of gram-negative bacteremia (incidence rates, 8% during the pre-intervention period vs. 20% after discontinuation; p<0.01). The resumption of fluoroquinolone prophylaxis in acute leukemia patients thereafter decreased the incidence of gram-negative bacteremia to the pre-intervention level (9%; p=0.03), while the proportion of in vitro fluoroquinolone resistance in E. coli bacteremia isolates again increased (from 15% during the intervention period to >50% in the post-intervention period). Relative rates of resistance thus were a poor indicator of the potential clinical benefits associated with fluoroquinolone prophylaxis in cancer patients.

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Estudio prospectivo y controlado, no aleatorizado, de tres cohortes sobre la efectividad de dos pautas antibióticas, levofloxacino y contrimoxazol, en profilaxis antibacteriana de pacientes neutropénicos

Cited by 5 publications

References 31 publications

Antibiotic prophylaxis in neutropenic patients

Antibiotic prophylaxis in neutropenic patients

Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression—a randomized pilot study during COVID-19

Fluoroquinolone resistance of Escherichia coli at a cancer center: epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia

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