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Alsajri A, Shubber M, Al-Qerem W. Cross-allergic reactions between etoposide and penicillin in autologous bone marrow transplant patient. IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Kirk A, Pierce J, Doll M, Lee K, Pakyz A, Kim J, Markley D, De la Cruz O, Bearman G, Stevens MP. Effect of carbapenem restriction on prescribing trends for immunocompromised wards at an academic medical center. Am J Infect Control 2019; 47:1035-1037. [PMID: 30732979 DOI: 10.1016/j.ajic.2018.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022]
Abstract
The recently described proportion of carbapenem consumption metric was used to assess the effectiveness of formulary restriction for carbapenems for 2 units housing predominantly immunocompromised patients at a large academic medical center. Interrupted time series analysis revealed a significant decrease in meropenem use for hematology-oncology and bone marrow transplant units after restriction.
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Affiliation(s)
- Andrew Kirk
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Jacob Pierce
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA
| | - Michelle Doll
- Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University Health System, Richmond, VA
| | - Kimberly Lee
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA
| | - Amy Pakyz
- Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Jihye Kim
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA
| | - Daniel Markley
- Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Oveimar De la Cruz
- Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University Health System, Richmond, VA
| | - Gonzalo Bearman
- Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University Health System, Richmond, VA
| | - Michael P Stevens
- Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University Health System, Richmond, VA.
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Decrease in vancomycin-resistant Enterococcus colonization associated with a reduction in carbapenem use as empiric therapy for febrile neutropenia in patients with acute leukemia. Infect Control Hosp Epidemiol 2019; 40:774-779. [PMID: 31046849 DOI: 10.1017/ice.2019.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the effects of empiric carbapenems versus cycling cefepime and piperacillin/tazobactam on the rates of vancomycin-resistant Enterococcus (VRE) colonization, bloodstream infections, and outcomes of patients admitted with acute leukemia. DESIGN Retrospective clinical study with VRE molecular strain typing and gastrointestinal microbiome comparison. SETTING A regional referral center for acute leukemia. PATIENTS 342 consecutive patients admitted with newly diagnosed acute leukemia. METHODS In September 2015, we changed our empiric antibiotic of choice for neutropenic fever from a carbapenem to the cycling regimen. We studied 214 consecutive patients during the carbapenem period and 128 during the cycling period. Surveillance for VRE stool colonization was conducted weekly. Representative stool samples were analyzed for VRE MLST types and changes in the composition and diversity of the fecal microbiota. RESULTS The change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.27-0.66), a switch in the dominant VRE MLST types on the unit, and some modifications in the gastrointestinal microbiome. There were no differences in total gram-positive or gram-negative BSIs. During the carbapenem period, we observed higher absolute numbers of Candida spp and fewer ESBL BSIs, but these did not reach statistical significance. Patients during the carbapenem period had longer lengths of stay and durations of severe neutropenia and 10% higher hospital cost. CONCLUSIONS Carbapenem-sparing empiric antibiotic regimens may have advantages related to VRE ecology, gastrointestinal dysbiosis, duration of neutropenia, cost and length of stay.
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Weinkove R, Bowden E, Wood C, Campion V, Carter J, Hall R, Weatherall M, Beasley R, Young P. A randomized controlled feasibility trial of paracetamol during febrile neutropenia in hemato-oncology patients. Leuk Lymphoma 2019; 60:1540-1547. [PMID: 30656993 DOI: 10.1080/10428194.2018.1538512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The efficacy of paracetamol (acetaminophen) as an antipyretic during febrile neutropenia (FN) has not previously been established. We conducted a randomized double-blind placebo-controlled feasibility trial: hemato-oncology patients at high FN risk were randomly assigned to six hourly oral paracetamol (1 g) or placebo during the first 42 hours of FN. Fifty-three participants were screened, thirty-seven enrolled; 22 developed FN and commenced treatment (13 paracetamol; 9 placebo); recruitment rates were below, and retention rates met, pre-defined feasibility criteria. During the first 24 hours of FN, paracetamol recipients had significantly lower peak temperature than placebo: mean 38.2 (standard deviation 0.8) °C versus 38.9 (0.4) °C; difference -0.78 °C (95% CI -1.38 to -0.18); p = .013. Bacterial load measurement was not informative. Paracetamol lowers body temperature during FN, and definitive trials to determine its impact on FN outcomes are needed. Australian New Zealand Clinical Trials Registry reference ACTRN12613000601730; funded by Health Research Council of New Zealand.
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Affiliation(s)
- Robert Weinkove
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,b Malaghan Institute of Medical Research , Wellington , New Zealand.,c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Emily Bowden
- c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Catherine Wood
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,b Malaghan Institute of Medical Research , Wellington , New Zealand
| | - Victoria Campion
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand
| | - John Carter
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Richard Hall
- d Institute of Environmental Science and Research , Upper Hutt , New Zealand
| | - Mark Weatherall
- e Department of Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Richard Beasley
- f Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Paul Young
- f Medical Research Institute of New Zealand , Wellington , New Zealand.,g Intensive Care Unit, Capital and Coast District Health Board , Wellington , New Zealand
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Khoo AL, Zhao YJ, Teng M, Ying D, Jin J, Chee YL, Poon LM, Lim SE, Koh LP, Chng WJ, Lim BP, Hsu LY, Chai LYA. Evaluation of a risk-guided strategy for empirical carbapenem use in febrile neutropenia. Int J Antimicrob Agents 2018; 52:350-357. [PMID: 29751120 DOI: 10.1016/j.ijantimicag.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
Febrile neutropenia (FN) is associated with substantial morbidity and necessitates empirical broad-spectrum antimicrobial treatment. In this prospective cohort study, a risk-guided management strategy for FN using empirical piperacillin/tazobactam (TZP) or a carbapenem was evaluated. The analysis involved 723 FN episodes in hospitalised adult patients, including those with severe sepsis or prior infection/colonisation with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Propensity score matching analysis was used to adjust for baseline differences between treatment groups and produced 267 matched pairs. The primary outcome was all-cause mortality. Secondary outcomes were the incidences of drug-resistant Gram-negative (including ESBL-producing) and Gram-positive bacterial isolates and of invasive pulmonary aspergillosis (IPA) and their associated mortality. There was no difference in mortality between empirical carbapenem and TZP [18/267 (6.7%) vs. 14/267 (5.2%); P = 0.466]. Higher incidences of drug-resistant Gram-negative isolates [77/267 (28.8%) vs. 26/267 (9.7%); P < 0.001], including ESBL-producing bacteria [57/267 (21.3%) vs. 16/267 (6.0%); P < 0.001], were observed in carbapenem-treated episodes where its use lowered mortality. Mortality rates for ESBL-positive infections were 5.3% (3/57) and 25.0% (4/16) (P = 0.037) and for drug-resistant Gram-negative infections were 6.5% (5/77) and 23.1% (6/26) (P = 0.018) in carbapenem- and TZP-treated episodes, respectively. More IPA was observed with carbapenem use [16/267 (6.0%) vs. 6/267 (2.2%); P = 0.029]. Antifungal prophylaxis reduced the risk of death (odds ratio = 0.39, 95% confidence interval 0.17-0.87; P = 0.017). Risk-guided carbapenem prescribing in FN correctly identified cases prone to drug-resistant Gram-negative infections and reduced the mortality in these episodes.
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Affiliation(s)
- Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Monica Teng
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Ding Ying
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Jing Jin
- Children's Minnesota Research Institute, Children's Hospitals and Clinics of Minnesota, Minneapolis-Saint Paul, MN, USA
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Mei Poon
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Liang Piu Koh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Li Yang Hsu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Department of Haematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
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Lucas N, Humble M, Sim D, Balm M, Carter J, Weinkove R. Temporal changes in neutropenic blood culture isolates and disease associations: a single centre series of 1139 episodes. Intern Med J 2017; 47:962-965. [PMID: 28782216 DOI: 10.1111/imj.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/26/2017] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
Abstract
Neutropenic infections are life-threatening and require empiric antibiotic treatment. We examined 1139 blood culture isolates from our institution over a 36-year period from neutropenic patients to examine temporal trends and disease associations. Positive associations were found between viridans streptococci and acute myeloid leukaemia, coagulase negative staphylococci and acute lymphoblastic leukaemia and Pseudomonas aeruginosa and indolent B-cell malignancies.
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Affiliation(s)
- Nathanael Lucas
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Michael Humble
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Dalice Sim
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Michelle Balm
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Wellington Southern Community Laboratories, Wellington Hospital, Wellington, New Zealand.,Infection Services, Capital and Coast District Health Board, Wellington, New Zealand
| | - John Carter
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand
| | - Robert Weinkove
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Malaghan Institute of Medical Research, Wellington, New Zealand.,Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand
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Jing Y, Li J, Yuan L, Zhao X, Wang Q, Yu L, Zhou D, Huang W. Piperacillin-tazobactam vs. imipenem-cilastatin as empirical therapy in hematopoietic stem cell transplantation recipients with febrile neutropenia. Clin Transplant 2016; 30:263-9. [PMID: 26701371 DOI: 10.1111/ctr.12685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Yu Jing
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
| | - Jian Li
- Department of Hematology; Peking Union Medical College Hospital; Beijing China
| | - Lei Yuan
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
| | - Xiaoli Zhao
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
| | - Quanshun Wang
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
| | - Li Yu
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
| | - Daobin Zhou
- Department of Hematology; Peking Union Medical College Hospital; Beijing China
| | - Wenrong Huang
- Department of Hematology and BMT; Chinese PLA General Hospital; Beijing China
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