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Kaakoua M, Boujmadi S, Belbaraka R, Essadi I. The Use of Granulocyte Colony-Stimulating Factor as Primary Prophylaxis in Patients Undergoing Chemotherapy: An Experience of Moroccan Oncologists. Cureus 2024; 16:e54482. [PMID: 38510886 PMCID: PMC10954314 DOI: 10.7759/cureus.54482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Febrile neutropenia (FN) is a frequent and serious emergency for oncologic patients undergoing chemotherapy. Using granulocyte colony-stimulating factor (G-CSF) as primary prophylaxis of febrile neutropenia is an integral part of the management of cancer patients. Our study aims to identify the challenges that prevent Moroccan oncologists from prescribing G-CSF for primary prevention. Seventy doctors participated in our study, with a participation rate of 35.35%. Twenty-two participants had at least five years of experience in oncology. Most participants were medical oncologists (82.9%), and two-thirds of them practiced in teaching hospitals. Regarding the use of G-CSF in primary prevention, all participants complied with the recommendations for FN risk assessment and the prescription of G-CSF for prophylaxis in patients at high risk of FN (>20%). However, their use in intermediate-risk patients remains limited mainly by the cost of these drugs (45.7% of participants). FN remains a dreadful complication in oncology. Since the introduction of G-CSF into standard oncology practice, particularly in primary prevention, the management of certain patients has improved considerably. Nevertheless, the indications for G-CSF in our context, essentially in intermediate-risk patients, are uncertain.
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Affiliation(s)
- Mohamed Kaakoua
- Medical Oncology Department, Ibn Sina Military Hospital, Marrakesh, MAR
| | - Soukayna Boujmadi
- Medical Oncology Department, Ibn Sina Military Hospital, Marrakesh, MAR
| | - Rhizlane Belbaraka
- Department of Medical Oncology, Mohammed VI University Hospital Center, Marrakesh, MAR
| | - Ismail Essadi
- Medical Oncology Department, Ibn Sina Military Hospital, Marrakesh, MAR
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Saseedharan S, Zirpe K, Mehta Y, Dubey D, Sutar A, Debnath K, Newale S. Efficacy and Safety of Oral and IV Levonadifloxacin Therapy in Management of Bacterial Infections: Findings of a Prospective, Observational, Multi-center, Post-marketing Surveillance Study. Cureus 2024; 16:e55178. [PMID: 38558736 PMCID: PMC10980586 DOI: 10.7759/cureus.55178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Antimicrobial resistance by bacteria poses a substantial threat to morbidity and mortality worldwide, and treatment of resistant infections is a challenge for the treating clinician. Levonadifloxacin is a novel broad-spectrum agent belonging to the benzoquinolizine subclass of quinolone, which can be used by both oral and intravenous administration for the treatment of infections caused by gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA). Patients and methods This prescription event monitoring study captured data from 1266 patients receiving levonadifloxacin (oral and/or IV) in a real-world setting to assess the safety and efficacy in the treatment of various bacterial infections. The duration of the study was 18 months. Study outcomes were clinical success and microbial success at the end of therapy. Global assessments were done for safety and efficacy at the end of therapy using a 5-point Likert scale (excellent, very good, good, satisfactory, and poor). Results The mean (median) duration of therapy was 7.2 (7.0) days, with a median time to clinical improvement of four days. Oral therapy was administered to 224 patients; 940 received IV, and 102 received IV followed by oral therapy. Patients were prescribed levonadifloxacin for gram-positive infections, skin and soft tissue infections, diabetic foot infections, septicemia, catheter-related blood-stream infections, bone and joint infections, febrile neutropenia, and respiratory infections, including COVID-19 pneumonia. The clinical cure on the eighth day was 95.7%, whereas the microbial success on the eighth day was 93.3% (n=60). For different types of infections, the clinical success rates ranged from 85.2% to 100%. There were only 30 treatment-emergent adverse events reported in 29 patients. Overall, about 95.6% of patients rated the efficacy as good to excellent, whereas only 3.8% of patients rated it satisfactory; for safety, 95.7% of patients rated it as good to excellent, with only 3.9% of patients rated it as satisfactory. Conclusions The excellent safety and efficacy profile of levonadifloxacin, when administered as an oral or intravenous therapy, makes it a desirable treatment modality for the management of various bacterial infections, including those caused by resistant pathogens such as MRSA and quinolone-resistant Staphylococcus aureus (QRSA). Features of levonadifloxacin, such as availability in both IV and oral form, minimal drug-drug interactions, lack of the need to adjust dosages in renal and hepatically impaired patients along with a broad spectrum of coverage, make it a suitable agent that meets several unmet clinical needs of physicians.
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Affiliation(s)
| | - Kapil Zirpe
- Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, IND
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurugram, IND
| | | | - Anand Sutar
- Critical Care Medicine, Apollo Hospitals, Bengaluru, IND
| | - Khokan Debnath
- Clinical Operations, Regulatory Affairs, Pharmacovigilance and Quality Assurance, Wockhardt Ltd., Mumbai, IND
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Bordbar M, Vahidifar M, Zarshenas MM, Haghpanah S, Zareifar S, Shahriari M, Zekavat OR, Karimi M, Fathpour G, Zargaran A, Shakibazad N. The efficacy of Allium ampeloprasum L. in reducing neutrophil recovery time in childhood cancer with febrile neutropenia: a randomized, double-blind, placebo-controlled trial. AMERICAN JOURNAL OF BLOOD RESEARCH 2023; 13:143-151. [PMID: 38023416 PMCID: PMC10658031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/01/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Febrile neutropenia is a serious complication of cancer chemotherapy that can result in delays in treatment. This study evaluates the efficacy of A. ampeloprasum L. at neutrophil recovery time in children with chemotherapy-associated febrile neutropenia. METHODS This single-center, parallel-group, double-blind, randomized clinical trial was conducted at an oncology hospital. Patients selected among childhood cancers with febrile neutropenia. Overall, 97 febrile neutropenic children were enrolled. The intervention group (n=49) was given A. ampeloprasum L. in capsules (500 mg twice daily) for seven days plus supportive care. The control group (n=48) was treated similarly with supportive care and placebo capsules. Total white blood cell (WBC) and absolute neutrophil counts (ANC) were checked daily and neutrophil recovery time in both groups was compared. RESULTS Patients in the intervention group experienced shorter neutrophil recovery compared to the control group (4.02 ± 2.32 days vs. 6.38 ± 2.80 days, respectively, P less than 0.001). The intervention group was discharged from the hospital earlier than the control group with a mean of two days, but it did not reach statistical significance (P=0.133). Mean WBC and ANC were not significantly different in the two groups. Herbal medicine was well tolerated, and no adverse effect was reported. CONCLUSIONS A fresh, lyophilized extract from deciduous leaves of A. ampeloprasum L. can effectively shorten the ANC recovery time leading to an earlier release from the hospital. The trial was registered in the Iranian Registry of Clinical Trials with registration No. IRCT2015051615666N2 (http://www.irct.ir/).
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Affiliation(s)
| | - Mehdi Vahidifar
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Shiraz University of Medical SciencesShiraz, Iran
| | | | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Soheila Zareifar
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Mahdi Shahriari
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Shiraz University of Medical SciencesShiraz, Iran
| | - Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
| | - Gholamreza Fathpour
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Shiraz University of Medical SciencesShiraz, Iran
| | - Arman Zargaran
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Tehran University of Medical SciencesTehran, Iran
| | - Nader Shakibazad
- Hematology Research Center, Shiraz University of Medical SciencesShiraz, Iran
- Department of Pediatric Hematology and Oncology, Bushehr University of Medical SciencesBushehr, Iran
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Raheja R, Reddy N, Patel T, Kilambi S, Mathew AA, Majeed A. Classification of Chemotherapy-Induced Febrile Neutropenic Episodes Into One of the Three Febrile Neutropenic Syndromes. Cureus 2023; 15:e42843. [PMID: 37664262 PMCID: PMC10472482 DOI: 10.7759/cureus.42843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Febrile neutropenia is a commonly encountered medical emergency in patients undergoing cancer treatment and can delay and modify the course of treatment and even lead to dire outcomes, including death. The cause of fever in a post-chemotherapy-induced neutropenic patient can be confusing to treating physicians. A review of the literature demonstrated that blood culture results could determine the cause of febrile neutropenia in only approximately 10% to 25% of patients. The objective of our study was to measure the incidence of positive blood cultures, urine cultures, and other body fluid cultures resulting in chemotherapy-induced neutropenia and further classify fever episodes into three neutropenic fever syndromes, such as microbiologically documented, clinically suspected, or unknown causes of fever, respectively. Methods We conducted a prospective observational study on 399 chemotherapy-induced neutropenic fever episodes with the aim of classifying them into one of the three neutropenic syndromes. We tried to document the cause of the fever in these patients. We also noted the type of cancer treatment regimen they were on and correlated their clinical profile with their body fluid cultures, including blood cultures, urine cultures, and other body fluid cultures. We then categorized each fever episode into one of three neutropenic syndromes. Results We studied 399 febrile neutropenic episodes. We were able to microbiologically document the cause of fever in 39% of the cases, and we obtained growth in 51 out of 399 blood cultures (13%), which was comparable to the available literature, and urine culture showed growth in 62 out of 399 cultures (16%), while other body cultures such as pus culture, bile culture, and bronchioalveolar lavage cultures collectively showed growth in 42 out of 399 episodes (10%). The most common bacteria isolated in both blood and urine cultures were Escherichia coli. Cumulatively, including blood, urine, and body fluid cultures, we were able to classify 39% (155 out of 399 cases) of febrile neutropenic episodes as microbiologically documented. The cause of fever was clinically suspected by means of careful history taking and an extensive physical examination in 31% (125 out of 399) without growth evidence in blood cultures, urine cultures, or any other body fluid culture. The cause of fever remained unknown in 119 cases (30%) of patients and was classified under the unknown cause of fever. Conclusions We conclude by stating that the study of fever in a neutropenic patient should include a thorough history and clinical evaluation of blood, urine, and other body fluid cultures instead of solely relying on blood culture results. We recommend further classifying patients into one of the three neutropenic fever syndromes, such as those that are microbiologically documented, clinically suspected, or unknown. Our blood cultures were able to give us a 13% positivity rate, whereas microbiologically, we were able to isolate an organism likely causing fever in 39% of patients. The cause of fever was suspected clinically in 31% of patients, but we were unsuccessful in microbiologically documenting any culture growth in blood, urine, or any other body fluid culture. The cause of fever remained a mystery and unknown to us without any microbiological or clinical cues in 119 cases (30%) of febrile neutropenic episodes.
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Affiliation(s)
- Ronak Raheja
- Department of Internal Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, IND
| | - Neelesh Reddy
- Department of Medical Oncology, Columbia Asia Referral Hospital Yeshwanthpur, Bangalore, IND
| | - Twinkle Patel
- Department of Internal Medicine, Shri Sathya Sai Medical College and Research Institute, Surat, IND
| | - Srikar Kilambi
- College of Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Ashik A Mathew
- Department of Pharmacology and Therapeutics, Manipal Hospitals, Bangalore, IND
| | - Abdul Majeed
- Department of Internal Medicine, Columbia Asia Referral Hospital Yeshwanthpur, Bangalore, IND
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John KR, Warrier A, Warrier A. Microbiological Spectrum of Neutropenic Sepsis in Cancer Patients Admitted to a Tertiary Health Care Centre. Cureus 2023; 15:e43898. [PMID: 37746392 PMCID: PMC10515477 DOI: 10.7759/cureus.43898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE To examine the microbiological profile, sensitivity of organisms, treatment and outcomes of in-patients suffering from febrile neutropenia in a tertiary healthcare centre. METHODS Data was obtained from the Electronic Medical Health records in Aster Medcity, Cochin, IND. The study population included adult patients undergoing treatment for hematologic malignancies or solid tumors in the hospital between January 2021 and March 2023. Febrile neutropenia episodes were identified based on (1) absolute neutrophil count ≤1500 mm3, (2) at least a single recorded oral temperature of >38.0∘C (100.4∘F) sustained over a one-hour period. Febrile neutropenia consequences included ICU admission, length of ICU admission, and mortality. RESULTS Total 115 cases of febrile neutropenia were identified in the time period from January 2021 to March 2023. Organisms were isolated from 43% of all the cultures taken. The most common organism isolated was Klebsiella pneumoniae (32.81%), followed by Escherichia coli (29.69%) and Pseudomonas aeruginosa (10.94%). Other organisms that were also isolated were Candida albicans (3.13%), Aeromonas hydrophilia, Acinetobacter baumannii, Burkholderia cepacia, Enterobacter cloacae, Enterococcus faecium, Staphylococcus epidermidis, Staphylococcus hemolyticus, Streptococcus spp, and one case of Ralstonia mannitolytica. Multi-drug resistance (MDR) was seen in 33% of isolates and extensive-drug resistance was seen in 19% of isolates. E. coli showed the highest prevalence of antibiotic resistance with 68% growing MDR isolates and 16% growing XDR isolates. ICU stay was required in 34% of patients with a median duration of stay of three days. A mortality rate of 16.52% was seen, with 17.11% in hematological malignancies and 15.38% in solid tumors. CONCLUSIONS This study showed an increasing prevalence of Gram-negative bacterial infection in patients with febrile neutropenia. It also shows a high prevalence of antibiotic resistance in microbes in febrile neutropenia. Larger multi-hospital studies are required to better understand the microbiological profile of febrile neutropenia and identify the developing antimicrobial resistance trends.
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Antimicrobial Stewardship Program for Patients in the Hematological Department Receiving Carbapenem Therapy: A Single-Center and Interrupted Time Series Analysis. Antibiotics (Basel) 2023; 12:antibiotics12020302. [PMID: 36830213 PMCID: PMC9951935 DOI: 10.3390/antibiotics12020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness of stewardship practices for immunocompromised patients remains uncertain. We determined the effect of AST interventions on carbapenem therapy in the department of hematology. Patients admitted to the department and undergoing carbapenem therapy were enrolled. We compared carbapenem use between the pre-AST (April 2016-March 2018) and post-AST (April 2018-March 2021) periods. Factors associated with long-term carbapenem therapy were investigated. Overall, 515 episodes of carbapenem therapy in 264 patients in the department were evaluated. According to the interrupted time series analysis, the number of days of therapy decreased with AST intervention (β = -0.263, p = 0.011). In multivariate analysis, predictive factors associated with long-term carbapenem therapy (>8 days) were outpatient onset, chronic obstructive pulmonary disease, acute myeloid leukemia, multiple myeloma, and infection with resistant bacteria (such as extended spectrum β-lactamases and AmpC) (95% confidence interval, 1.030-2.818, 1.067-66.667, 1.057-2.782, 0.168-0.742, and 1.382-5.750, respectively). The AST intervention reduced carbapenem use in patients with hematological disorders.
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Al Battashi A, Al Harrassi B, Al Maskari N, Al Hashami H, Al Awaidy S. Alarming Antibiotic Resistance in Pediatric Oncology Patients: A Three-Year Prospective Cohort Study from Oman. Infect Drug Resist 2022; 15:3939-3947. [PMID: 35915810 PMCID: PMC9338433 DOI: 10.2147/idr.s369909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Bloodstream infections (BSI) are severe and challenging oncological complications, with a consequent high morbidity and mortality in the immunocompromised. We reviewed the profile and susceptibility of bacteria associated with infections in children under 13 years of age receiving chemotherapy. Methods Prospective cohort study of pediatric oncology patients was conducted between January 2015 and October 2017 at the Royal Hospital in Oman. Patient demographics, clinical data, laboratory parameters, microbial etiology and susceptibility, and outcomes were retrieved and analyzed. Results A total of 74 episodes of positive bacterial blood cultures were detected in 38 oncology patients (positive blood culture rate of 51%). Fifty-seven percent were positive for gram-negative organisms with Klebsiella (21%) being the most common gram-negative organism cultured, and the most common gram-positive organism was Staphylococcus (coagulase negative Staphylococcus (CONs) and S. Aureus) (30%). The majority of patients had gastrointestinal complaints (74%), and almost half (51%) had prolonged periods of neutropenia (>7 days). One third of gram-negative organisms were resistant to four or more antibiotics with a major resistance of 31% to piperacillin-tazobactam. Of the gram-positive organisms, 38% were resistant to at least four antibiotics and 30% were pan-resistant (except for vancomycin). Conclusion The gram-negative organisms were dominant in BSIs with Klebsiella being the most common culprit. Bacteremia was prevalent, however, high resistance to first-line antibiotics was documented amongst gram-negative isolates, demanding strategies to ensure our patients’ safety.
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Affiliation(s)
- Abeer Al Battashi
- Department of Pediatric Hematology and Oncology, The National Oncology Centre, Royal Hospital, Ministry of Health, Muscat, Oman
| | | | - Nawal Al Maskari
- Pediatric Infectious Diseases, Child Health Department, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Hilal Al Hashami
- Pediatric Infectious Diseases, Child Health Department, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Salah Al Awaidy
- Office of Health Affairs, Ministry of Health, Muscat, Oman
- Correspondence: Salah Al Awaidy, Office of Health Affairs, Ministry of Health, Al Khuwair Street, Muscat, Oman, Tel +968 99315063, Fax +968 24946381, Email
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Mahtani RL, Belani R, Crawford J, Dale D, DeCosta L, Gawade PL, Huynh C, Lawrence T, Lewis S, MacLaughlin WW, Narang M, Rifkin R. A prospective cohort study to evaluate the incidence of febrile neutropenia in patients receiving pegfilgrastim on-body injector versus other options for prophylaxis of febrile neutropenia: breast cancer subgroup analysis. Support Care Cancer 2022; 30:6135-6144. [PMID: 35426046 PMCID: PMC9009498 DOI: 10.1007/s00520-022-07025-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer chemotherapy often carries a high risk of febrile neutropenia (FN); guidelines recommend prophylaxis with granulocyte colony-stimulating factor (G-CSF), such as pegfilgrastim. Neulasta® Onpro® on-body injector (OBI) is a delivery device administering pegfilgrastim approximately 27 h after application. METHODS This prospective study examined patients with breast cancer who received chemotherapy with a high risk of FN, receiving OBI ("OBI") or other options (other G-CSF or none; "other"). The primary endpoint was FN incidence; secondary endpoints included chemotherapy delivery, adherence (G-CSF in all cycles), compliance (G-CSF day after chemotherapy), and FN incidence in patients receiving curative or palliative treatment. RESULTS A total of 1776 patients with breast cancer were enrolled (OBI, n = 1196; other, n = 580). Across all cycles, FN incidence was lower for OBI (4.4% [95% CI, 3.3-5.6%]) than other (7.4% [5.3-9.6%]). For curative treatment, the FN incidence across all cycles was lower for OBI (4.6% [3.4-5.8%]) than for other (7.1% [5.0-9.3%]). For palliative treatment (OBI, n = 33; other, n = 20), 3 patients (15%) in the other and none in the OBI group had FN. After adjusting for baseline covariates, FN incidence remained lower for OBI (4.6% [3.5-6.1%]) versus other (7.8% [5.7-10.5%]). Adherence was higher for OBI (93.8%) than for other G-CSF (69.8%), as was compliance (90.5 and 53.2%, respectively). Chemotherapy dose delays/reductions were similar for OBI (4.7%/32.3%, respectively) and other (4.7%/30.0%) groups. CONCLUSION Pegfilgrastim OBI was associated with a lower FN incidence in patients with breast cancer compared to other options for FN prophylaxis. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT02178475, registered 30 June, 2014.
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Affiliation(s)
- Reshma L Mahtani
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
| | | | | | - David Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Chanh Huynh
- Cancer Care Associates of York, York, PA, USA
| | | | | | | | | | - Robert Rifkin
- Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO, USA
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Haddad S, Jabbour JF, Hindy JR, Makki M, Sabbagh A, Nayfeh M, Boustany M, El-Zein S, Tamim H, Zakhem AE, El Cheikh J, Bazarbachi A, Kanj SS. Bacterial bloodstream infections and patterns of resistance in patients with haematological malignancies at a tertiary centre in Lebanon over 10 years. J Glob Antimicrob Resist 2021; 27:228-235. [PMID: 34607062 DOI: 10.1016/j.jgar.2021.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Bacterial bloodstream infections (BSIs) with resistant pathogens in patients with haematological malignancies are rising due to increased use of novel chemotherapeutic agents and prophylactic antibiotics. Our goal was to understand the epidemiology and resistance patterns of bacterial pathogens in patients with haematological malignancies to help tailor empirical antibiotics and to limit resistance. METHODS This was a retrospective chart review looking at bacterial BSI episodes between 2007-2017 in patients previously diagnosed with haematological malignancy at a tertiary-care centre in Lebanon. RESULTS Among 165 hospitalised patients with haematological malignancy and bacterial BSI over 10 years, Gram-negative bacteria (GNB) caused 65.0% of all episodes, with the most common pathogens being Escherichia coli (45.6%), 79.6% of which were ESBL-producers, Pseudomonas aeruginosa (7.5%) and Acinetobacter baumannii (4.0%). The majority of the organisms (61.0%) were multidrug-resistant (MDR), with ANC < 100 neutrophils/μL (OR = 0.12, 95% CI 0.03-0.54) identified as an independent marker for increased multidrug resistance. The risk factors associated with increased mortality included recent use of amikacin (p<0.001) and infections with organisms resistant to amikacin (p<0.001) or ciprofloxacin (p=0.04). Our results reflect a persistent pattern of Gram-negative predominance with E. coli remaining the most common isolated pathogen in bacterial BSIs in patients with haematological malignancies. The relative frequency of GNB to Gram-positive bacteria remains similar to our data from 2007. CONCLUSION The persistent divergence between worldwide data and the results observed in our centre and the increasing rates of MDR pathogens emphasise the importance of tailoring empirical antimicrobial therapy according to the centre's epidemiology.
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Affiliation(s)
- Sara Haddad
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean-Francois Jabbour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joya-Rita Hindy
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sabbagh
- American University of Beirut, Beirut, Lebanon
| | | | | | - Saeed El-Zein
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline El Zakhem
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El Cheikh
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
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Rahi MS, Jindal V, Pednekar P, Parekh J, Gunasekaran K, Sharma S, Stender M, Jaiyesimi IA. Fungal infections in hematopoietic stem-cell transplant patients: a review of epidemiology, diagnosis, and management. Ther Adv Infect Dis 2021; 8:20499361211039050. [PMID: 34434551 PMCID: PMC8381463 DOI: 10.1177/20499361211039050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/24/2021] [Indexed: 12/18/2022] Open
Abstract
The advent of bone marrow transplant has opened doors to a different approach and
offered a new treatment modality for various hematopoietic stem-cell-related
disorders. Since the first bone marrow transplant in 1957, there has been
significant progress in managing patients who undergo bone marrow transplants.
Plasma-cell disorders, lymphoproliferative disorders, and myelodysplastic
syndrome are the most common indications for hematopoietic stem-cell transplant.
Despite the advances, invasive fungal infections remain a significant cause of
morbidity and mortality in this high-risk population. The overall incidence of
invasive fungal infection in patients with hematopoietic stem-cell transplant is
around 4%, but the mortality in patients with allogeneic stem-cell transplant is
as high as 13% in one study. Type of stem-cell transplant, conditioning regimen,
and development of graft-versus-host disease are some of the
risk factors that impact the risk and outcomes in patients with invasive fungal
infections. Aspergillus and candida remain the two most common organisms causing
invasive fungal infections. Molecular diagnostic methods have replaced some
traditional methods due to their simplicity of use and rapid turnaround time.
Primary prophylaxis has undoubtedly shown to improve outcomes even though
breakthrough infection rates remain high. The directed treatment has seen a
significant shift from amphotericin B to itraconazole, voriconazole, and
echinocandins, which have shown better efficacy and fewer adverse effects. In
this comprehensive review, we aim to detail epidemiology, risk factors,
diagnosis, and management, including prophylaxis, empiric and directed
management of invasive fungal infections in patients with hematopoietic
stem-cell transplant.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA
| | - Vishal Jindal
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Prachi Pednekar
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Jay Parekh
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Sorabh Sharma
- Department of Internal Medicine, Banner University Medical Center, Tucson, AZ, USA
| | - Michael Stender
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Ishmael A Jaiyesimi
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
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Belančić A, Stanić Benić M, Skočibušić N, Palčevski D, Vlahović-Palčevski V. Repeated point prevalence survey on antimicrobial use in a university hospital: what have we learned? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:362-368. [PMID: 34117882 DOI: 10.1093/ijpp/riab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the quality of antimicrobial prescribing, at the Department of Internal Medicine University Hospital Centre Rijeka, by assessing the necessity for antimicrobial treatment and adherence to the local Guidelines for hospital antimicrobial drug use and to compare results with previously conducted point prevalence surveys (PPSs). METHODS A PPS was conducted on 7th May 2019. Demographic and relevant clinical data of each patient receiving systemic antimicrobials were recorded anonymously in a patient-specific form. The appropriateness of antibiotic prescribing was assessed as adherence to the fourth edition of the Guidelines for hospital antimicrobial drug use. KEY FINDINGS One hundred and seventy-one patients were hospitalized at the Department of Internal Medicine; 37.4% (n = 64) of patients received 102 prescriptions for an antimicrobial drug [62.8% (n = 64) of prescriptions were for intravenous and 37.2% (n = 38) for oral administration]. Of these, 52 were treated for an identified existing infection, 5 were treated for an unknown indication and 7 received antibiotics as prophylaxis. The necessity for antimicrobial treatment was unclear in 19.3% (n = 11) of cases. The antimicrobials were prescribed according to the Guidelines in 65.4% (n = 34) of cases. Adherence to the Guidelines when treating lower respiratory tract infections, urinary tract infections and gastrointestinal tract infections was 47.8%, 55.6% and 92.9%, respectively. CONCLUSIONS Our study revealed antibiotic prescription frequency similar to EU/EEA average and high percentage of unjustified antimicrobial treatment introduction. The rate of adherence to the Guidelines was lower than those observed in western countries. The results lay a basis for tailoring antimicrobial stewardship programs/activities.
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Affiliation(s)
- Andrej Belančić
- Department of Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Nataša Skočibušić
- Department of Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Dora Palčevski
- Department of Emergency Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia.,Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
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12
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Antimicrobial prophylaxis and post-chemotherapy neutropenic fever in patients with leukemia: comparisons of C-reactive protein, procalcitonin and immediate fever outcome measures between those with and without prophylaxis, and the implications for practice. Support Care Cancer 2021; 29:7515-7523. [PMID: 34101015 PMCID: PMC8550747 DOI: 10.1007/s00520-021-06325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Abstract
Purpose The efficacy of prophylactic antimicrobial treatment renders challenges in patients with leukemias receiving chemotherapy. The study aimed to compare differences in C-reactive protein (CRP) and procalcitonin (PCT) at presentation and the immediate outcome measures of post-chemotherapy NF between patients with and without antimicrobial prophylaxis. Methods A 5-year observational study included 282 NF episodes in 133 leukemia patients requiring hospital care from January 2014 to May 2019. We collected demographic characteristics, laboratory data of blood cell counts and inflammatory biomarkers, and immediate outcome measures of NF, including microbiologically diagnosed infections, presence of predominant pathogens, required modification of antibiotics during NF, adverse medical complications, total fever duration, and deaths. We evaluated data between patients with and without prophylaxis. Results Of patients, 77.3%, 68.4%, and 20.6% had antibiotic prophylaxis, antifungal prophylaxis, and no prophylaxis, respectively. There were totally 15 deaths—13 with antibiotic prophylaxis and 10 with antifungal prophylaxis. CRP, PCT, and immediate outcome measures of NF did not show significant differences between those with and without antimicrobial prophylaxis. Although between-group differences showed no statistical significance, higher median fever duration, CRP and PTC values, and higher proportions of NF requiring modification of antibiotics were found more frequently in those with antimicrobial prophylaxis than in those without. Conclusion The benefits of using antimicrobial prophylaxis were less supported. Enhancing diagnostic laboratory and medical complication surveillance and periodic evaluation of institutional data during post-chemotherapy neutropenia and NF in relation to antimicrobial prophylaxis is promising in providing insights to redefine the risk–benefit accounts of using prophylaxis.
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Jahan D, Peile E, Sheikh MA, Islam S, Parasnath S, Sharma P, Iskandar K, Dhingra S, Charan J, Hardcastle TC, Samad N, Chowdhury TS, Dutta S, Haque M. Is it time to reconsider prophylactic antimicrobial use for hematopoietic stem cell transplantation? a narrative review of antimicrobials in stem cell transplantation. Expert Rev Anti Infect Ther 2021; 19:1259-1280. [PMID: 33711240 DOI: 10.1080/14787210.2021.1902304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hematopoietic Stem Cell Transplantation (HSCT) is a life-saving procedure for multiple types of hematological cancer, autoimmune diseases, and genetic-linked metabolic diseases in humans. Recipients of HSCT transplant are at high risk of microbial infections that significantly correlate with the presence of graft-versus-host disease (GVHD) and the degree of immunosuppression. Infection in HSCT patients is a leading cause of life-threatening complications and mortality. AREAS COVERED This review covers issues pertinent to infection in the HSCT patient, including bacterial and viral infection; strategies to reduce GVHD; infection patterns; resistance and treatment options; adverse drug reactions to antimicrobials, problems of antimicrobial resistance; perturbation of the microbiome; the role of prebiotics, probiotics, and antimicrobial peptides. We highlight potential strategies to minimize the use of antimicrobials. EXPERT OPINION Measures to control infection and its transmission remain significant HSCT management policy and planning issues. Transplant centers need to consider carefully prophylactic use of antimicrobials for neutropenic patients. The judicious use of appropriate antimicrobials remains a crucial part of the treatment protocol. However, antimicrobials' adverse effects cause microbiome diversity and dysbiosis and have been shown to increase morbidity and mortality.
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Affiliation(s)
- Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, 111/1/A Distillery Road, Gandaria Beside Dhupkhola, Dhaka 1204, Bangladesh
| | - Ed Peile
- Department of Medical Education, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Sharlene Parasnath
- Department of Clinical Hematology, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Cato Manor, Durban, South Africa
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Katia Iskandar
- Lebanese University, School of Pharmacy, Beirut, Lebanon.,INSPECT-LB: Institute National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Universite Paul Sabatier UT3, INSERM, UMR1027, Toulouse, France
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Timothy Craig Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa.,Department of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN, South Africa
| | - Nandeeta Samad
- Department of Public Health, North South University, Bangladesh
| | | | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, Malaysia
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Kristian Kur D, Thøgersen D, Kjeldsen L, Friis-Hansen L. The HemoScreen hematology point-of-care device is suitable for rapid evaluation of acute leukemia patients. Int J Lab Hematol 2020; 43:52-60. [PMID: 32894640 DOI: 10.1111/ijlh.13330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hematological patients, receiving intensive chemotherapy (predominantly acute leukemia patients), have repeated postchemotherapy periods with severe bone marrow suppression. As a result, these patients require regular monitoring of the complete blood counts (CBC) for optimal patient care. To reduce the strain on the patient, there is a need for a point-of-care (POC) hematology device that provides rapid and reliable results both in general and in cytopenic samples and is suitable for outpatient clinics. We evaluated the HemoScreen device for the most used CBC parameter both overall and at the lower range. METHODS The HemoScreen was compared with the Sysmex XN-9000 in 206 routine venous samples and 79 capillary bedside samples focusing on white blood cells (WBC), absolute neutrophil count (ANC), red blood cells (RBC), PLT and HGB. RESULTS The HemoScreen was less precise compared to the acceptance criteria set for larger and more advanced hematology instrument with a CV% 3.0-3.7 for WBCs, 3.6-8.4 for ANCs, 1.1-1.5 for RBCs, 2.5-4.4 for PLTs, and 1.7-2.3 for HGB. Correlation coefficient for all five parameters for the entire range was r >.95 and r >.90 at lower range for venous and capillary samples. Bias limits were within the CTCAE acceptance limits. CONCLUSIONS The HemoScreen provides rapid and accurate test results, for evaluation of WBC, PLT, and HGB, as well as at low concentrations for guiding transfusions and postchemotherapy treatment. The device is easy to operate and can measure both venous and capillary samples. Therefore, the HemoScreen is well suited for smaller outpatient clinics and potentially home use.
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Affiliation(s)
- Dår Kristian Kur
- Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Danny Thøgersen
- Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hilleroed, Denmark
| | - Lars Kjeldsen
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, North Zealand Hospital, University of Copenhagen, Hilleroed, Denmark.,Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period. PLoS One 2019; 14:e0224299. [PMID: 31671108 PMCID: PMC6822758 DOI: 10.1371/journal.pone.0224299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
For better management of patients with febrile neutropenia, our study investigated the epidemiologic, microbiologic, and clinical characteristics of adult inpatients with febrile neutropenia and their mortality-associated factors. To this end, we carried out a prospective, observational, multicenter study in 28 Argentinian hospitals between 2007 and 2012. We included 515 episodes of febrile neutropenia from 346 patients, median age 49 years. Neutropenia followed chemotherapy in 77% of cases, half of the cases due to hematological malignancies. Most episodes were classified as high-risk according to MASCC criteria, and 53.6% of patients were already hospitalized at the onset of febrile neutropenia. Bloodstream infections were detected in 14% episodes; whereas an infectious source of fever was identified in 80% of cases. Mortality rate achieved to 14.95%. The binary regression analysis showed that persistence of fever at day 7, or neutropenia at day 14, dehydration and tachycardia at the onset of febrile neutropenia as well as prior infections were significantly associated with mortality. In addition to expanding our current knowledge on the features of adult patients with febrile neutropenia, present findings provide useful information for better management of them in Argentina, given the appropriate representativeness of centers participating in the study.
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16
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Carvalho AS, Lagana D, Catford J, Shaw D, Bak N. Bloodstream infections in neutropenic patients with haematological malignancies. Infect Dis Health 2019; 25:22-29. [PMID: 31586572 DOI: 10.1016/j.idh.2019.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/23/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with haematological malignancies have higher risk of acquiring bloodstream infection (BSI). Neutropenia resulting from cytotoxic chemotherapy is the most common risk factor. Infections can progress rapidly with poor outcomes. Understanding the epidemiology may enable prevention and effective management. We investigated and compared the incidence of BSI amongst patients with haematological malignancies and neutropenia and examined the changing spectrum of organisms, and their antimicrobial profiles. METHODS BSI data between July 1st 2009 and June 30th 2015 was reviewed. RESULTS Three hundred and fifty five BSI were identified in 255 neutropenic patients. Acute myeloid leukaemia (AML) accounted for 40%, Non-Hodgkin's lymphoma for 22% and Acute lymphocytic leukaemia (ALL) for 11.8%. A neutrophil count of <500 cells/μL was present in 93.2%. The overall incidence was 5.40 BSI per 1000 Haematology Occupied Bed days (OBD). Viridans streptococci and Enterococcus species were the most predominant Gram-positives. Vancomycin resistant Enterococcus faecium (VRE) emerged as the predominant Enterococcus species during the study period. Escherichia coli was the most predominant Gram-negative and Extended-spectrum beta-lactamases (ESBL) were detected in 7.1% of isolates. Amongst the Enterobacteriaceae and Pseudomonas aeruginosa dual resistance to Piperacillin-tazobactam and Gentamicin was detected in 5.4%. CONCLUSION Our incidence of BSI was 5.40 per 1000 OBD, however variability in reporting of rates in neutropenic patients with haematological malignancies makes comparison between studies difficult, highlighting the need for rate reporting standardization. The epidemiology of organisms causing BSI has changed over time. There is a trend towards an increasing incidence of VRE and multidrug resistant Gram-negatives.
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Affiliation(s)
- Ana Sofia Carvalho
- Infectious Diseases Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia
| | - Diana Lagana
- Infection and Prevention Control Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia.
| | - Jennifer Catford
- Infectious Diseases Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia
| | - David Shaw
- Infectious Diseases Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia
| | - Narin Bak
- Infectious Diseases Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia; Infectious Diseases Unit, The Queen Elizabeth Hospital, Adelaide, Australia
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Corrigendum to "Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update". Adv Hematol 2019; 2019:4120631. [PMID: 31379947 PMCID: PMC6662276 DOI: 10.1155/2019/4120631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
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18
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Jacquet J, Catala G, Machiels JP, Penaloza A. Neutropénie fébrile aux urgences, stratification du risque et conditions du retour à domicile. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La neutropénie fébrile (NF) est une situation fréquemment rencontrée aux urgences avec un taux de mortalité non négligeable variant de 5 à 40 %. Cette variabilité importante met en avant l’importance de stratifier le risque afin de permettre un traitement ambulatoire per os de certains patients à faible risque. En plus du MASCC (The Multinational Association for Supportive Care in Cancer) score, d’autres outils permettent d’évaluer ce risque ou sont à l’étude dans ce but, tels que le dosage de la CRP, la procalcitonine ou encore le score CISNE. Après une prise en charge rapide aux urgences incluant l’administration sans délai d’un traitement adéquat, la poursuite de l’antibiothérapie per os à domicile est envisageable chez les patients à faible risque. La combinaison amoxicilline–acide clavulanique et ciprofloxacine est le plus souvent recommandée, mais la moxifloxacine ou la lévofloxacine en monothérapie peuvent également être utilisées pour les patients traités à domicile. Le retour à domicile permet de réduire fortement les coûts engendrés par l’hospitalisation, de diminuer le risque d’infection nosocomiale et d’améliorer la qualité de vie des patients avec NF à faible risque. Dans cette optique, plusieurs critères doivent être remplis, et une discussion avec le patient reste primordiale à la prise de décision. Parmi ceux-ci, nous retiendrons notamment un score MASCC supérieur à 21, une durée attendue de neutropénie inférieure à sept jours, l’accord du patient et de son entourage ainsi que la proximité entre le domicile et un service de soin adapté.
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Jamal A, Fatima N, Shaikh S, Kaleem B, Rizvi QA, Zaidi U, Borhany M, Shamsi T. Pattern of Antimicrobial Sensitivity in Microbiologically Documented Infections in Neutropenic Patients with Haematological Malignancies: A single Center Study. Indian J Microbiol 2019; 59:188-192. [PMID: 31031433 DOI: 10.1007/s12088-019-00789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Febrile neutropenia is a medical emergency that complicates the clinical course and treatment of haematological malignancies, significantly enhancing the financial burden and worsening the overall outcome. This study was carried out to evaluate the efficacy of institution's current first-line antibiotic regimen for febrile neutropenia in view of recent spectrum of institution's local flora and its susceptibility pattern. 163 episodes of microbiologically documented infections in 110 adult patients were studied over a period of 1 year. Of 110 patients, 61 patients were male. The mean age of the patient population, mean absolute neutrophil count and temperature as documented were 30.1 years (SD ± 16.8), 450 cells/ul, and 101.9 °C respectively. Gram-negative and gram-positive organisms accounted for 79% and 21% of the febrile neutropenic infections respectively. E. coli and Staphylococcus aureus were the most common gram positive and gram negative pathogens respectively. A susceptibility pattern of > 60% was documented for all the gram negative pathogen's associated febrile neutropenic infections for the current first-line antibiotic combination of Piperacillin/Tazobactum and Amikacin. Comparative analysis of results with the institutional data of 2015 study revealed no statistically significant difference in the resistance pattern of the organisms hence, validating the persistent use of Piperacillin/Tazobacum and Amikacin combination as a potent and efficacious therapy for febrile neutropenia patients with haematological malignancies. However, continuous surveillance remains prudent for the emerging changes in the spectrum and resistance pattern of local flora so that timely revision of empirical antibiotic regimens can save the added financial burdens and associated high morbidity and mortality.
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Affiliation(s)
- Aisha Jamal
- 1Department of Clinical Haematology and BMT, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Naveena Fatima
- 2Department of Clinical Research & Development, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Sajjad Shaikh
- 3Department of Microbiology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Bushra Kaleem
- 2Department of Clinical Research & Development, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Qurratul Ain Rizvi
- 1Department of Clinical Haematology and BMT, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Uzma Zaidi
- 1Department of Clinical Haematology and BMT, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Munira Borhany
- 1Department of Clinical Haematology and BMT, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Tahir Shamsi
- 1Department of Clinical Haematology and BMT, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
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The Influence of Diabetes Mellitus on Glucuronidation and Sulphation of Paracetamol in Patients with Febrile Neutropenia. Eur J Drug Metab Pharmacokinet 2018; 44:289-294. [PMID: 30187443 PMCID: PMC6418056 DOI: 10.1007/s13318-018-0508-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Numerous studies have confirmed the influence of diabetes mellitus on the pharmacokinetics of drugs. Paracetamol (APAP) is an antipyretic that is commonly used in febrile neutropenia (FN) therapy. APAP is chiefly metabolised by glucuronidation and sulphation. This study assessed the influence of diabetes on the pharmacokinetics of paracetamol and its metabolites: glucuronide (APAP-glu) and sulfate (APAP-sulfate) in FN patients. METHODS Patients with FN received single intravenous dose 1000 mg of APAP. The FN patients were allocated to one of two groups: diabetics (DG, n = 7) or non-diabetics (NDG, n = 11). The plasma concentrations of paracetamol and its metabolites were measured with the validated high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection. RESULTS Pharmacokinetic parameters (mean [SD]) of APAP in the DG and NDG groups were as follows: Cmax (maximum comcentration) = 21.50 [11.23] vs. 23.42 [9.79] mg/L, AUC0-t (area under the concentration-time curve) = 44.23 [17.93] vs. 41.43 [14.57] mg·h/L, t1/2kel (elimination half-life) = 2.28 [0.80] vs. 2.11 [0.80] h. In both groups the exposure to APAP was comparable. The study did not reveal differences between the two groups in the pharmacokinetics of APAP-glu and APAP-sulfate. The Cmax and AUC0-t ratio between the metabolites and APAP were similar. CONCLUSIONS No differences in the pharmacokinetics of APAP, APAP-glu and APAP-sulfate in patients with FN indicates that diabetes does not influence glucuronidation and sulfatation of paracetamol.
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Idelalisib impairs TREM-1 mediated neutrophil inflammatory responses. Sci Rep 2018; 8:5558. [PMID: 29615799 PMCID: PMC5882939 DOI: 10.1038/s41598-018-23808-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022] Open
Abstract
Triggering receptor expressed on myeloid cells (TREM)-1 on polymorphonuclear neutrophils (PMN) regulates innate immune activation in infectious and non-infectious conditions. TREM-1 ligation activates phosphatidyl-inositol 3 kinase (PI3K) triggering all neutrophil effector functions. As idelalisib is a PI3K inhibitor in clinical use for the treatment of non-Hodgkin lymphomas, we asked whether this inhibitor affects PMN functionalities. We analyzed PMNs from healthy donors or lymphoma patients for oxidative burst, phagocytosis, activation markers and IL-8 release upon TREM-1 or TLR ligation ex vivo. In addition, we performed western blot analyses to characterize the signaling events inhibited by idelalisib and other PI3K inhibitors. Upon TREM-1 ligation, the oxidative burst, degranulation, L-selectin shedding and cytokine release were all strongly reduced in the presence of idelalisib along impaired phosphorylation of P38, AKT and ERK by western blot analyses. In line with this, PMNs from patients receiving idelalisib also displayed an impaired TREM-1 mediated PMN activation ex vivo. In conclusion, PI3K inhibitors might cause a neutropenia-like susceptibility to infections in patients by leading to impaired PMN functionality. This should be considered when evaluating patients for infections treated with such inhibitors in daily clinical routine.
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Presepsin as a diagnostic marker of bacterial infections in febrile neutropenic pediatric patients with hematological malignancies. Int J Hematol 2018; 108:184-191. [DOI: 10.1007/s12185-018-2447-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 01/27/2023]
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Tadmor T, Welslau M, Hus I. A review of the infection pathogenesis and prophylaxis recommendations in patients with chronic lymphocytic leukemia. Expert Rev Hematol 2017; 11:57-70. [DOI: 10.1080/17474086.2018.1407645] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Manfred Welslau
- Haemato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
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Shaffer K, Bach J, Chun R. Prospective study evaluating the incidence of bacteraemia and bacteruria in afebrile and febrile neutropaenic dogs undergoing chemotherapy. Vet Med Sci 2017; 2:281-294. [PMID: 29067203 PMCID: PMC5645853 DOI: 10.1002/vms3.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 07/26/2016] [Accepted: 08/31/2016] [Indexed: 12/29/2022] Open
Abstract
The purpose of this prospective study was to determine the incidence and character of bacteraemia and bacteruria in afebrile and febrile neutropaenic dogs undergoing cytotoxic chemotherapy. Fifty‐five neutropaenic dogs presenting to the University of Wisconsin Veterinary Medical Teaching Hospital were enrolled for a total of 57 neutropaenic episodes. The overall incidence of bacteraemia was 12.3% (n = 7/57). Three afebrile dogs and four febrile dogs were bacteraemic; this difference was not significant (P = 0.6968). The overall incidence of bacteruria was 7.5% (n = 4/53). Two afebrile dogs and two febrile dogs were bacteruric; this difference was not significant (P = 1.0). Of the positive blood cultures, the majority of organisms cultured (n = 6/7) were gram‐positive organisms with one gram‐negative organism. Three of the positive blood cultures showed in vitro resistance to more than one antimicrobial agent. Clinical parameters (age, body weight, heart rate, rectal temperature, neutrophil count, haematocrit and platelet count) were not predictive of bacteraemia. The results of this study were not sufficient to justify the use of blood cultures as a first‐line diagnostic test for neutropaenic patients. Blood cultures may have utility in individual case management for a minority of patients in guiding antibiotic choice in the case of resistant bacterial infections. Blood cultures may serve as a tool for antimicrobial de‐escalation, although further study is needed.
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Affiliation(s)
- Kimberly Shaffer
- Department of Medical SciencesSchool of Veterinary MedicineVeterinary Medical Teaching HospitalUniversity of Wisconsin-MadisonMadisonWisconsinUSA
| | - Jonathan Bach
- Department of Medical SciencesSchool of Veterinary MedicineVeterinary Medical Teaching HospitalUniversity of Wisconsin-MadisonMadisonWisconsinUSA
| | - Ruthanne Chun
- Department of Medical SciencesSchool of Veterinary MedicineVeterinary Medical Teaching HospitalUniversity of Wisconsin-MadisonMadisonWisconsinUSA
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Wang XJ, Chan A. Optimizing Symptoms and Management of Febrile Neutropenia among Cancer Patients: Current Status and Future Directions. Curr Oncol Rep 2017; 19:20. [PMID: 28271398 DOI: 10.1007/s11912-017-0578-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Febrile neutropenia (FN) is a common and serious complication among cancer patients undergoing myelosuppressive chemotherapy. FN should be treated as a medical emergency because it can lead to life-threatening complications if appropriate treatment is not initiated immediately. This study provides a critical review on the current management of FN and identifies possible directions to optimize FN management.
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Affiliation(s)
- Xiao Jun Wang
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, 169610, Singapore.
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Przybylski DJ, Reeves DJ. Moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy. Support Care Cancer 2017; 25:3715-3721. [PMID: 28660351 DOI: 10.1007/s00520-017-3797-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. There is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting. METHODS A retrospective chart review was completed comparing the use of prophylactic moxifloxacin to that of levofloxacin or ciprofloxacin during periods of prolonged neutropenia. Adult patients admitted to a community teaching hospital while receiving induction or reinduction chemotherapy for acute myeloid leukemia were included. RESULTS One hundred and forty-one patients were included in this study. The two groups displayed slight heterogeneity: patients receiving moxifloxacin were approximately 10 years younger (54 vs. 64 years, p = 0.01), more likely to receive granulocyte colony stimulating factor (GCSF) (45 vs. 19%, p = 0.001), and neutropenic for a longer duration (23 vs. 19 days, p = 0.009). The incidence of febrile neutropenia (76 vs. 81%, RR 0.93, 95% CI 0.78-1.11, p = 0.42) and of documented infections (27 vs. 33%, RR 0.82, 95% CI 0.49-1.36, p = 0.44) was similar between those receiving moxifloxacin and levofloxacin/ciprofloxacin, respectively. Hospital readmission for an infectious issue within 30 days of hospital discharge (9 vs. 5%, p = 0.39) was also similar between groups as was the incidence of Clostridium difficile (9 vs. 9%, p = 0.96). CONCLUSIONS Moxifloxacin may be an alternative to levofloxacin or ciprofloxacin in patients with a prolonged risk of febrile neutropenia requiring prophylaxis.
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Affiliation(s)
- Daniel J Przybylski
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.,Department of Pharmacy, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA
| | - David J Reeves
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA. .,Department of Pharmacy, St. Vincent Indianapolis Hospital, Indianapolis, IN, USA.
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Spinardi JR, Berea R, Orioli PA, Gabriele MM, Navarini A, Marques MT, Neto MN, Mimica MJ. Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer. Germs 2017. [PMID: 28626736 DOI: 10.18683/germs.2017.1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections. METHODS In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile. RESULTS S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients. CONCLUSION Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.
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Affiliation(s)
- Julia R Spinardi
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Rodrigo Berea
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Patricia A Orioli
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marina M Gabriele
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Alessandra Navarini
- PhD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marina T Marques
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Milton N Neto
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marcelo J Mimica
- MD, PhD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
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Conn JR, Catchpoole EM, Runnegar N, Mapp SJ, Markey KA. Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection. PLoS One 2017; 12:e0178059. [PMID: 28542412 PMCID: PMC5438184 DOI: 10.1371/journal.pone.0178059] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/08/2017] [Indexed: 02/03/2023] Open
Abstract
Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a “real world” cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period. In this cohort, the 30-day mortality following confirmed blood stream infection (BSI) was 5.9%, which is lower than most reports in the recent literature. We compared the blood culture results of inpatients undergoing induction chemotherapy and outpatients presenting with fevers and found a significantly higher rate of proven BSI in the outpatient group. In all settings, gram-negative organisms were most common. The rate of resistance to first-line empiric antibiotics among pathogenic isolates was 11.6% in the whole cohort, independent of blood culture circumstances. There was a trend to higher resistance rates among inpatients undergoing induction chemotherapy compared to patients presenting to the emergency department (17.4% vs 7.5%) but this did not reach statistical significance. We also report low rates of ciprofloxacin resistance (5% of isolates), in a center where universal fluoroquinolone prophylaxis is not employed. Our low resistance and mortality rates support our current therapeutic strategies, however presence of resistant organisms across the spectrum of indications for BC collection highlights the importance of surveilling local patterns, escalating antimicrobial therapy in the deteriorating patient, and considering advanced techniques for the rapid identification of resistance in this patient population.
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Affiliation(s)
- Jason R. Conn
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Naomi Runnegar
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sally J. Mapp
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Kate A. Markey
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Haematology and Bone Marrow Transplantation Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
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Khwaja S, Yacoub A, Cheema A, Rihana N, Russo R, Velez AP, Nanjappa S, Sandin RL, Bohra C, Gajanan G, Greene JN. Marijuana Smoking in Patients With Leukemia. Cancer Control 2017; 23:278-83. [PMID: 27556668 DOI: 10.1177/107327481602300311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.
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Affiliation(s)
- Sara Khwaja
- Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Fruehauf S, Otremba B, Stötzer O, Rudolph C. Compatibility of Biosimilar Filgrastim with Cytotoxic Chemotherapy during the Treatment of Malignant Diseases (VENICE): A Prospective, Multicenter, Non-Interventional, Longitudinal Study. Adv Ther 2016; 33:1983-2000. [PMID: 27743353 PMCID: PMC5083766 DOI: 10.1007/s12325-016-0419-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Indexed: 11/17/2022]
Abstract
Introduction Febrile neutropenia (FN) is a serious and frequent complication of cytotoxic chemotherapy. Biosimilar filgrastim (Nivestim™, Hospira Inc, A Pfizer Company, Lake Forest, IL, USA) is a granulocyte-colony stimulating factor licensed for the treatment of neutropenia and FN induced by myelosuppressive chemotherapy. The primary goal of this VENICE study (ClinicalTrials.gov identifier, NCT01627990) was to observe the tolerability, safety and efficacy of biosimilar filgrastim in patients receiving cancer chemotherapy. Methods This was a prospective, multicenter, non-interventional, longitudinal study. Consenting adult patients with solid tumors or hematologic malignancies for whom cytotoxic chemotherapy and treatment with biosimilar filgrastim was planned were enrolled. Results Among the enrolled patients (N = 386), 81% were female, with a median age (range) of 61 (22–92) years, with 39% >65 years old. Most patients (n = 338; 88%) had solid tumors and the remainder (n = 49; 13%) had hematological malignancies. The majority of the patients (64%) received biosimilar filgrastim as primary prophylaxis and 36% as secondary prophylaxis. At the follow-up visits, for the majority of patients (95.6%) there had been no change in chemotherapy dose due to FN. For two patients (0.5%) the chemotherapy was discontinued due to FN and for four patients (1.0%) the chemotherapy dose was reduced due to FN. For the majority of patients (96.9%) the chemotherapy cycle following the first biosimilar filgrastim treatment was not delayed due to FN. For 3 patients (0.8%), the chemotherapy was delayed following the first biosimilar filgrastim treatment. Less than one-third (29.8%) of the patients experienced ≥1 adverse event that was at least potentially related to biosimilar filgrastim treatment. Conclusions Biosimilar filgrastim was effective and well-tolerated in both the primary and secondary prophylactic setting in patients undergoing chemotherapy for solid tumors and hematological malignancies. Trial Registration ClinicalTrials.gov identifier, NCT01627990. Funding Hospira Inc, A Pfizer Company, Lake Forest, IL, USA.
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Daptomycin for Gram-positive Infections in Patients with Neutropenia: Clinical Experience from a European Outcomes Registry. Adv Ther 2015; 32:715-26. [PMID: 26239201 PMCID: PMC4569678 DOI: 10.1007/s12325-015-0231-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Indexed: 12/03/2022]
Abstract
Introduction The aim of this analysis was to describe in real-world settings the clinical outcomes and safety associated with daptomycin treatment in patients with neutropenia and Gram-positive infections. Methods Patients with an absolute neutrophil count (ANC) ≤1000 cells/mm3 who received at least one dose of daptomycin between 2006 and 2012 were selected from a non-interventional, multicenter, retrospective registry (European Cubicin® Outcome Registry and Experience; EU-CORESM). Results Of the 6075 patients enrolled in EU-CORE, 446 (7.3%) had an ANC ≤ 1000 cells/mm3 at baseline or during daptomycin therapy; they were all included in efficacy and safety populations. Half of the patients had severe neutropenia (ANC ≤ 100 cells/mm3). Most patients had hematologic malignancy (60.5%), an immunosuppressed state (39.7%) or had undergone a transplant (27.8%). The most common primary infections were bacteremia (42.2%) and complicated skin and soft tissue infection (13.9%). Cultures were positive for 68.6% (254/370) of patients with available culture results; coagulase-negative staphylococci (43.7%; 111/254) and Staphylococcus aureus (18.9%; 48/254) were the most commonly isolated primary pathogens. Median duration of daptomycin therapy was 10.0 (range 1–98) days. Most patients (82.8%) received antibiotics concomitantly with daptomycin; the most common were carbapenems (51.2%), penicillins (42.1%), and aminoglycosides (19.9%). The overall clinical success rate (cured or improved) associated with daptomycin was 77.1%. Adverse events possibly related to daptomycin treatment were reported in seven (1.6%) patients and led to drug discontinuation in 27 (6.1%) patients. Conclusion The study results suggest that daptomycin is an effective therapeutic option for the treatment of a broad range of Gram-positive infections in patients with neutropenia, and has a good safety profile. Funding This study was funded by Novartis Pharma AG. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0231-3) contains supplementary material, which is available to authorized users.
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