Gangrenous cellulitis associated with gram-negative bacilli in pancytopenic patients: Dilemma with respect to effective therapy

Kusne, Shimon; Eibling, David E.; Yu, Victor J.; Fitz, David; Johnson, Jennifer M.; Kahl, Leslie E.; Ellis, Lawrence D.

doi:10.1016/0002-9343(88)90634-1

Cited by 3 publications

(4 citation statements)

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“…Bacterial and fungal infections occurring in immunocompromised patients, particularly those with prolonged severe neutropenia, represent a frequent cause of morbidity and mortality (Kusne et al , 1988; Denning, 1994). Although current therapeutic approaches use combinations of broad‐spectrum antibiotics, antifungal agents and haemopoietic cytokines, septic complications are still a serious problem in these patients (Link et al , 1994) and clearance of the infectious pathogen is often possible only in the presence of an adequate number of neutrophils.…”

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confidence: 99%

Leucocyte transfusions from rhG‐CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients

et al. 1999

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Summary. Sepsis in profound neutropenia after chemotherapy is associated with high mortality despite appropriate antibacterial or antifungal treatment. In a prospective phase I/II study we evaluated the feasability and ef®cacy of leucocyte transfusions (LT) in patients with malignancies or haematological disorders who were suffering from severe bacterial or fungal infection during therapy-related bone marrow aplasia. 30 patients with severe neutropenia and clinical signs of life-threatening sepsis not responding to adequate treatment, received LT from rhG-CSF-stimulated family donors or from prednisolone-primed volunteers. A total of 301 LT were administered. The median number of LT per patient was seven (range three to 65), the median duration of LT treatment was 8 d (range 2±35). The white cell count (WBC), absolute neutrophil count (ANC) and lymphocyte count of the concentrates from rhG-CSFstimulated donors were signi®cantly higher than those from prednisolone-primed volunteers (P 0´0001). Despite the critical condition of the patients, LT were generally well tolerated. Only 39 (12´9%) LT were associated with adverse reactions. The transfusion of leucocytes collected by continuous¯ow leukapheresis from both rhG-CSF and prednisolone stimulated donors resulted in a measurable increment of the peripheral leucocyte and ANC counts in our patients. On day 100 after the ®rst LT, 20/30 patients were alive with complete clearance of the infection.

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Leucocyte transfusions from rhG‐CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients

et al. 1999

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“…Necrotizing fasciitis has been portrayed in diabetic hosts and neutropenic patients. 27 Serious burn wounds Pseudomonas is obtained, and their colonization happens when ordinary skin, respiratory, gastrointestinal flora is replaced by nosocomial organism like P. aeruginosa colonize a little while after a few weeks of initial burn. 28…”

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confidence: 99%

Retrospective comparative study of Pseudomonas aeruginosa antibiotic resistance isolated from intensive care units (ICUs) patients from tertiary hospital in Nepal

Paneru¹

2022

JMEN

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This finding has examined the persistent emergence of resistance among P. aeruginosa strains to common antimicrobial drugs vis a-vis the increasing number of reports documented world-wide. Our study objectives were finding the antimicrobial resistance patterns of P. aeruginosa from clinical isolates obtained from hospitalized patients. The main purpose of this study was aimed to perform antibiotic resistance patterns among the P aeruginosa isolates from ICU units in tertiary hospitals in Nepal. Two hundred and fifty strains of P. aeruginosa were isolated from different clinical specimens and fully characterized by regular standard bacteriological proceedings between March 1998 and November 2003. Antimicrobial susceptibility patterns of each isolate were carried out by the Kirby- Bauer disk diffusion method as per guidelines of CLSI. These initial laboratory findings of antibiotic resistance of P. aeruginosa isolates have been compared for next successive 17 years to find the significant antimicrobial resistances rise if any from the data. Primarily for the initial 3 years of study, Majority of high antibiotic resistance isolates of P. aeruginosa were obtained from specimens of pus, sputum, urine, and tracheal aspirates. The isolated pathogens showed resistance to amikacin (18.45%), ciprofloxacin (28.32%) and Cefoperazon-sulbactam (36.42%). Resistance rates to Co-trimoxazole, piperacillin, ceftriaxone and chloramphenicol varied from 49.00% to 71.00%. Most of the isolates were susceptible to imipenem. 21.67% of P. aeruginosa isolates were found to be multi-drug resistant. The results also established clear evidence of drug resistant strains of P. aeruginosa. Imipenem, amikacin, and ciprofloxacin were found to be the mainly effective antibiotics. From ICUs isolates, resistance rates were found to be the highest. It therefore demands a very well thought-out and cognizance treatment regimen by the general practitioners to hinder the further spread of P. aeruginosa antimicrobial resistance. We therefore analyzed current and long-term trends of antibiotic resistance within our hospitals, including separate analysis of trends for ICUs. Secondly, pathogenic P. aeruginosa species isolated at the tertiary teaching hospital throughout the 17-year period from the records was analyzed. There was a considerable rise in resistance over a decade in the bacterial species of P. aeruginosa in the successive years. The tendency of ciprofloxacin resistance was on the rise for the entire tertiary teaching hospital from 2.5% in 2003 to 12.5% in 2011 (P<0.01, Spearman rank order correlation). In addition to this, there was an increase in resistance in the ICUs, but in common lower than that for the whole hospital. A remarkable resistance increase was observed for imipenem first and foremost noticeable in the ICUs compared to the other hospital units. Similarly, the resistance to ceftazidime, piperacillin and gentamicin at the tertiary teaching hospital noticed a noticeable rise, specifically in the ICUs.

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“…The reports in the literature are unanimous in their emphasis on the initial role of early surgical intervention for prevention of the potentially severe consequences in NF patients [5]. However, problems of providing an effective therapy relate to the following: (1) establishing the correct diagnosis prior to the characteristic cutaneous manifestations, (2) bleeding diatheses in pancytopenic patients and (3) evaluation of the major cosmetic deformity [5].…”

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“…However, problems of providing an effective therapy relate to the following: (1) establishing the correct diagnosis prior to the characteristic cutaneous manifestations, (2) bleeding diatheses in pancytopenic patients and (3) evaluation of the major cosmetic deformity [5]. In these patients, rapid decision and surgical planning are critical.…”

mentioning

confidence: 99%

Extensive necrotising fasciitis caused by Pseudomonas aeruginosa in a child with acute myeloid leukaemia: case report and literature review

Cheng

Wang

et al. 2004

Eur J Pediatr

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Gangrenous cellulitis associated with gram-negative bacilli in pancytopenic patients: Dilemma with respect to effective therapy

Cited by 3 publications

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Leucocyte transfusions from rhG‐CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients

Leucocyte transfusions from rhG‐CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients

Retrospective comparative study of Pseudomonas aeruginosa antibiotic resistance isolated from intensive care units (ICUs) patients from tertiary hospital in Nepal

Extensive necrotising fasciitis caused by Pseudomonas aeruginosa in a child with acute myeloid leukaemia: case report and literature review

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