Science and pragmatism in the treatment and prevention of neutropenic infection

Klastersky, Jean

doi:10.1093/jac/41.suppl_4.13

Cited by 100 publications

(64 citation statements)

References 54 publications

(51 reference statements)

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“…In a seminal study from 1965, Bodey et al [4] followed 52 patients aged 1-77 years with a newly diagnosed acute leukaemia and found that the incidence of infectious episodes decreased with increasing levels of circulating granulocytes and lymphocytes. Fever and infections as a consequence of neutropenia mainly in acute leukaemia or agranulocytosis, were first described about 100 years ago [5]. In the 1960s, the attention to severe infections among patients with haematological or other malignancies increased, due to better antineoplastic treatment.…”

Section: Febrile Neutropeniamentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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Abstract:Patients with haematological malignancies are at increased risk of infections not only because of the malignancy itself but also because of neutropenia induced by intensive chemotherapeutic treatment, and the cytotoxic effect on the cells that line the alimentary tract. In haematological malignancy patients with a compromised inflammatory response, the classic signs and symptoms of infection may be masked. The results of blood cultures therefore play an important diagnostic role. Bacteraemia is a relatively common serious complication occurring in around 15% of patients with haematological malignancies within the first years after diagnosis but the risk varies between different types of haematological malignancies. Other risk factors for bacteraemia are presence of mucositis, neutropenia, and use of central venous catheters. Invasive fungal diseases are also serious infectious complications in this population. Viral infections are particularty often in patients that have received a bone marrow transplant. Future work in this field could focus on potential modifiable risk factors and on how time since haematological diagnosis may influence risk of infection.

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Section: Febrile Neutropeniamentioning

confidence: 99%

Risk of Infections in Adult Patients with Haematological Malignancies

Nørgaard¹

2012

TOIDJ

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“…The most severe bacterial infections in these patients are bloodstream infections (bacteraemia) with or without a site of primary infection. The Infectious Diseases Group of the European Organization for Research and Treatment of Cancer (EORTC-IDG) trials had a 32% rate of bacteraemia in 1973, which dropped to 22% in 1994 [1]. However, their experience was that the proportion of Gram-positive and Gram-negative pathogens causing bacteraemia changed over this time period.…”

Section: Introductionmentioning

confidence: 99%

“…However, their experience was that the proportion of Gram-positive and Gram-negative pathogens causing bacteraemia changed over this time period. The proportion of Gram-negative and Gram-positive pathogens went from 71 and 29%, respectively, in 1973-1978 to 33 and 67% in 1992-1994 [1]. But since the beginning of the new century, Gram-negative bacilli have re-emerged [2].…”

Section: Introductionmentioning

confidence: 99%

Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Bloodstream Infections in Children with Febrile Neutropenia: Experience of Single Center in Southeast of Turkey

et al. 2011

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Empirical antimicrobial therapy is usually started in febrile neutropenic patients without having culture results. The aim of this study was to help determine the policies of empirical antibiotic usage in febrile neutropenic children by detecting the antimicrobial susceptibility profile in this group of patients. In this study 811 blood cultures taken from neutropenic children hospitalized at the Department of Oncology of Gaziantep Children Hospital November 2007 and February 2010 were retrospectively evaluated. Blood cultures were routinely collected in aerobic and anaerobic media and incubated using the BACTEC system. Identification and antimicrobial susceptibility testing of the isolates to antimicrobial agents was performed using the Vitek2 Ò system according to the recommendations of the Clinical and Laboratory Standards Institute. Of 811 isolates analyzed, 128 (56.4%) were gram positive cocci, 43 (18.9%) were gram negative bacilli and fungi accounted for 56 (24.7%). The main isolated Gram-positive bacteria from blood were coagulase-negative staphylococcus (56.7%), followed by methicillin-resistant Staphylococcus aureus (14.1%). S. aureus and Streptococcus spp. were all susceptible to linezolid, vancomycin and teicoplanin. S aureus was still susceptible to few other antimicrobial agents such as tetracycline (82.4%), chloramphenicol (55.6%). Seven E. faecium, 7 E. fecalis and 1 E. hirae was isolated from blood cultures. Vancomycin resistance was detected in 6 out of 15 (40%) Enterococcus spp. isolates. Among gram-negative bacteria E. coli (30.2%) was followed by Klebsiella pneumoniae (20.9%) and Proteus spp. (18.6%). Imipenem (89.2%), meropenem (86.6%), chloramphenicol (88.9%), amicasin (82.4%) and fosfomycin (81.3%) showed highest susceptibility in vitro activity against all Gram-negative isolates. To know the antimicrobial susceptibility profile of the pathogens frequently isolated from febrile neutropenic children and to consider this profile before starting an empirical antibiotic therapy would help the clinics which have any role in the treatment of these patients to determine the empirical antibiotic usage policies.

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“…Bu sonuçlar, nötropenik hastalar ve solid organ nakli sonrası erken dönem hastalardaki bakteriyemilerin en sık etkenlerinin Gram-pozitif bakteriler olduğunu bildiren Amerika, Avrupa ve Asya kaynaklı çalışmaların sonuçlarından farklı bulunmuştur (7)(8)(9)(10). Brezilya'dan Silva ve arkadaşları (11) Çalışmamızda, kaynağına göre bakteriyemi sınıflaması yapıldığında sekonder bakteriyemiler (%47.9) en sık görü-len grubu ve karın içi infeksiyonlar (%42.5) da en sık kaynağı oluşturdu.…”

Section: İrdelemeunclassified

The Distribution and Antimicrobial Susceptibility Profiles of Etiologic Agents Isolated From Bacteremia Episodes Among Immunocompromised Patients

Demirkaya¹,

Yeşilkaya²,

Ok³

et al. 2017

Klimik Dergisi

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Objective: Bacteremia is the leading cause of morbidity and mortality among immunocompromised patients. The aim of this study is to evaluate the etiology of bacteremia and the antibiotic susceptibilities of etiologic agents among immunocompromised patients followed up from January 1, 2012 to July 30, 2013. Methods: Immunocompromised patients, both inpatient and outpatient treated in our hospital, were followed prospectively. The definition of "immunocompromised patients" consisted of solid organ (kidney, liver) transplantation recipients and hemato-oncologic malignancy patients with a history of chemotherapy in the previous month before bacteremia. Results: This prospective study comprised of 167 bacteremia episodes of 130 consecutive immunocompromised patients. The most isolated group of bacteria was Gram-negative bacteria. Escherichia coli was the most commonly (30.8%) isolated bacteria and the second was coagulase-negative staphylococci (15.1%). Fifty one percent of the E. coli isolates were extended-spectrum β-lactamasepositive. Acinetobacter baumannii was the second most common bacteria of Gram-negative agents and the ratio of multiple drugresistant (MDR) isolates among Acinetobacter isolates was 73%. Conclusions: Gram-negative bacteria are the most common causative agents of bacteremia in immunocompromised patients in our hospital. The rising ratio of MDR A. baumannii is a striking problem which causes difficult-to-treat infections.

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Science and pragmatism in the treatment and prevention of neutropenic infection

Cited by 100 publications

References 54 publications

Risk of Infections in Adult Patients with Haematological Malignancies

Risk of Infections in Adult Patients with Haematological Malignancies

Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Bloodstream Infections in Children with Febrile Neutropenia: Experience of Single Center in Southeast of Turkey

The Distribution and Antimicrobial Susceptibility Profiles of Etiologic Agents Isolated From Bacteremia Episodes Among Immunocompromised Patients

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