Meropenem monotherapy versus combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients

Behre, Gerhard; Link, Hartmut; Maschmeyer, Georg; Meyer, Peter; Paaz, U.; Wilhelm, Martin; Hiddemann, Wolfgang

doi:10.1007/s002770050366

Cited by 49 publications

(17 citation statements)

References 36 publications

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“…In the present study the febrile neutropenic episodes consisted of 12.8% of clinically documented infection, 30.8% microbiologically documented infections and 56.4% fever of unknown origin. This occurrence is similar to that reported by Behre et al [10] consisting of episodes in patients with and without central venous access. However in large trials, clinically defined infection was reported in 26% of the episodes [11].…”

Section: Discussionsupporting

confidence: 91%

Febrile Neutropenia in Patients with Acute Leukemia with Long-Term Central Venous Access in Kuwait: Microbial Spectrum, Outcome and Catheter Management

Bahar¹,

Pandita²,

Bavishi³

et al. 2000

Med Princ Pract

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Objective: This study was conducted to investigate the microbial spectrum, outcome and catheter management in febrile neutropenic acute leukemia patients with long-term central venous access, at a single center in Kuwait. Methods: One hundred and thirty-three febrile neutropenic episodes in 64 adult acute leukemia patients with long-term central venous access encountered at the Kuwait Cancer Control Centre were studied. The frequency of clinically documented infections, microbiologically documented infections, fevers of unknown origin and catheter-related infection was determined. Response to treatment and the need for catheter removal were studied. Results: In the 133 febrile neutropenic episodes, clinically documented infections, microbiologically documented infections and fever of unknown origin occurred in 12.8, 30.8 and 56.4%, respectively. Thirty-two episodes of catheter-related infections were encountered. Gram-positive and gram-negative infections occurred in equal frequency. Escherichia coli and methicillin-resistant Staphylococcus aureus were the most frequent organisms. Of all episodes, 87.2% responded to antibiotics and 11 episodes required removal of the catheter. Of the clinically documented infections, 76.5% of the episodes responded to treatment without catheter removal. Of the microbiologically documented episodes, 68.3% were treated successfully without removal of the catheter. One hundred percent of the episodes of fever of unknown origin responded to a broad spectrum of antibiotics, without catheter removal. Conclusion: Gram-negative and gram-positive infections occur in equal frequency in febrile neutropenic acute leukemia patients with long-term central venous catheters. E. coli and methicillin-resistant S. aureus are the most frequent organisms and the majority of the episodes are curable by antimicrobial therapy without the removal of the catheter.

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Section: Discussionsupporting

confidence: 91%

Febrile Neutropenia in Patients with Acute Leukemia with Long-Term Central Venous Access in Kuwait: Microbial Spectrum, Outcome and Catheter Management

Bahar¹,

Pandita²,

Bavishi³

et al. 2000

Med Princ Pract

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“…We have published the algorithm used for febrile neutropenic children in our hospital [13,14]. Single-agent therapy became a possibility when broadspectrum antibiotics, such as third-and fourth-generation cephalosporins with anti-Pseudomonas activity (ceftazidime or cefepime), ureidopenicillins with β-lactamase inhibitors, and carbapenems, became available [15][16][17][18][19]. Meropenem is a carbapenem, which has a broad spectrum of antimicrobial activity [20,21].…”

Section: Discussionmentioning

confidence: 99%

Meropenem in the Treatment of Febrile Neutropenic Children

Müller

Garami

Constantin

et al. 2005

Pediatric Hematology and Oncology

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The aim of this retrospective study was to evaluate the clinical effectiveness of meropenem in immunocompromised children. Between January 1998 and December 2002 in the hemato-oncological units of our hospital meropenem was used in 87 febrile events diagnosed in 55 patients, and 328 bacterial cultures were evaluated. Microorganisms were detected and identified in 64 of the 328 hemocultures; there was a predominance of gram-positive strains (67%). In 49.4% the infection was documented microbiologically. In 16 additional cases the infection was proven clinically and 32.2% of the episodes were considered to be fever of unknown origin. The success rate of the meropenem therapy-excluding the proven fungal or coagulase-negative Staphylococcus infections--was 72.9% and for the whole cohort 49.4%. The results demonstrate that meropenem is effective and well-tolerated when used for the treatment of neutropenic cancer children.

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“…Single agent regimens have been proven to be equivalent to combination treatment [11][12][13][14][15][16][17][18][19][20]. Th us a fi rst-line treatment with a pseudomonas aeroginosa-covering β-lactam antibiotic is recommended.…”

Section: Anti-infective Treatment Of Febrile Neutropeniamentioning

confidence: 99%