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Query: UMLS:C0004610 (bacteremia)
 13,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with hematologic malignancy are susceptible to infection because of the disease process and its treatment. Profoundly granulocytopenic patients are at increased risk of developing Pseudomonas aeruginosa bacteremia, often with a fatal outcome. Therapy with one or two anti-pseudomonal beta-lactam antibiotics and an aminoglycoside in combination that were effective in vitro against the infecting organism proved to be superior, by one-week survival, to therapy with either one in vitro effective beta-lactam or aminoglycoside or inadequate drugs. On the other hand, treatment with granulocyte colony-stimulating factor had no significant association with longer survival, although a favorable outcome was well correlated with an increase in the granulocyte count during therapy. An active mycobacteriosis was documented in 2% of all patients with hematologic malignancy. Dissemination occurred in half of them. The prognosis of tuberculosis was depended mainly on early diagnosis and treatment, while that for the atypical variety was largely influenced by the underlying disease. The frequency of deep fungal infection in patients with acute leukemia at autopsy increased progressively from 10% in 1970-1974 to 38% in 1983-1986, but it decreased somewhat to 29% in 1987-1989 after the introduction of empiric amphotericin B therapy in 1986. Early empiric antifungal therapy should therefore be started in granulocytopenic patients with fever refractory to antibacterial therapy, because of unreliability of the current serodiagnosis. A total protective isolation for patients undergoing bone marrow transplantation (BMT) was associated with a reduced incidence of pneumonia, especially due to Aspergillus, and to a lesser extent, bacteremia. Cytomegalovirus pneumonia complicating BMT continues to have a poor prognosis, although the frequency has gradually been decreasing with the introduction of effective preventive measures. An early diagnosis and treatment as well as preventive measures is thus necessary for infection control in patients with hematologic malignancy.
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PMID:[Clinical approach to infection in patients with hematologic malignancy]. 137 Oct 45

The efficacy of recombinant human granulocyte colony-stimulating factor (G-CSF) in the treatment of Pseudomonas aeruginosa bacteremia in cancer patients receiving intensive chemotherapy was studied retrospectively. In 14 of the 24 episodes of P. aeruginosa bacteremia, which occurred in 23 severely neutropenic patients with hematologic malignancies during a three-year period, G-CSF was given subcutaneously or intravenously at daily doses of 75 micrograms/body to 200 micrograms/m2 of body surface. Overall, survival at one week after onset was observed in 13 patients (54%). Treatment with G-CSF, however, had no statistically significant association with one-week survival, although a favorable outcome was well correlated with an increase in the neutrophil count during therapy. On the other hand, septic shock and appropriate antibiotic therapy were the major prognostic factors. The frequency of shock was reduced by appropriate therapy, but not by G-CSF treatment. These preliminary findings thus suggested that G-CSF should not be effective in the treatment of neutropenic cancer patients with P. aeruginosa bacteremia. No adverse effects of G-CSF were observed.
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PMID:Effect of recombinant human granulocyte colony-stimulating factor (G-CSF) in the treatment of Pseudomonas aeruginosa bacteremia complicating hematologic malignancy--a preliminary study. 138 55

Ethanol is a potent immunosuppressive agent that impairs neutrophil effector function. The purpose of this study was to determine whether granulocyte colony-stimulating factor (G-CSF), a cytokine that increases neutrophil number and functional activity, could prevent the ethanol-induced impairment of antibacterial host defense. Rats were injected with human recombinant G-CSF for 2 days. Eight hr after the last injection of G-CSF, animals were infused with ethanol (or saline) for 1 hr before the subcutaneous injection of live Escherichia coli. The infusion of alcohol was continued after the bacterial challenge and produced blood alcohol levels of 275-300 mg/dl. In control animals, the injection of E. coli resulted in a marked leukopenia. There was an influx of leukocytes into the subcutaneous space where the bacteria were injected, and neutrophil accumulation in tissues adjacent to the focus of infection (i.e., dorsal skin and muscle). Based on myeloperoxidase activity, there was no detectable accumulation of neutrophils in other soft tissues. In acutely intoxicated rats, leukocyte migration to the inflammatory site was impaired, and the number of viable bacteria isolated from the subcutaneous pocket was markedly increased. G-CSF prevented the sepsis-induced leukopenia, increased the influx of neutrophils in to the infection site, reduced the number of bacteria in the subcutaneous lavage fluid, and decreased the incidence of bacteremia in ethanol-treated rats when compared with rats not receiving G-CSF. These results demonstrate that G-CSF is a potent immunomodulator that stimulates neutrophil recruitment selectively to the site of infection and that can be used to ameliorate the ethanol-induced impairment in bacterial host defense.
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PMID:Granulocyte colony-stimulating factor prevents ethanol-induced impairment in host defense in septic rats. 750 76

Sepsis is a common cause of morbidity and mortality. Neutrophils are the major defense against bacterial invasion, and granulocyte colony-stimulating factor (G-CSF) augments both neutrophil number and function. In our study, 160 rabbits were inoculated transtracheally with 0.5 mL of a solution containing 10(4) colony forming units per milliliter of Pasteurella multocida. Twenty-four hours later, chest x-rays and quantitative blood cultures demonstrated pneumonia and bacteremia. Therapy was then begun with penicillin G and either recombinant human G-CSF (rG-CSF; 5 to 8 micrograms/kg subcutaneously) or placebo every day for 5 days. Arterial blood gases and 23 other parameters of organ function were performed before inoculation and serially thereafter. All rabbits underwent histologic examination of organs at the time of septic death or when sacrificed on day 6. A total of 149 rabbits survived long enough to initiate therapy. A significant increase in leukocytes by day 4 was found in the rG-CSF-treated group. There was a trend towards improved survival in the rG-CSF group (77% v 67%; P = .13, n = 149). Analysis of pretreatment variables revealed sepsis-induced leukopenia (< or = 2,800/microL) as the only predictor of significantly improved survival with rG-CSF treatment (57% v 39%; P = .04, n = 73). The majority of the survival benefit occurred within the first 24 hours of treatment. This was before the time that a significant difference in mean white blood cell (WBC) count was observed between the study groups, making intravascular leukocytosis an unlikely explanation for the survival advantage in the rG-CSF group. No significant difference in laboratory variables reflecting organ function was demonstrated between the groups. Histologic grading of inflammation (0, normal, to 6, necrosis) in seven organs revealed that the surviving rabbits had mild but statistically significant increased inflammation in the liver, spleen, and noninoculated lung in the rG-CSF versus placebo groups (liver: 2.6 v 1.5, P < or = .0001; spleen: 3.2 v 2.3, P < or = .0001; and noninoculated lung: 2.9 v 2.5, P = .04). Administration of rG-CSF, in addition to penicillin G, in immune competent rabbits with gram-negative sepsis complicated by leukopenia significantly improved survival over antibiotics alone. The administration of rG-CSF in early sepsis for a short therapeutic duration was not associated with any clinically evident toxicity. Clinical trials using rG-CSF in septic patients with leukopenia are indicated.
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PMID:Granulocyte colony-stimulating factor versus placebo in addition to penicillin G in a randomized blinded study of gram-negative pneumonia sepsis: analysis of survival and multisystem organ failure. 754 3

The therapeutic efficacy of granulocyte colony-stimulating factor (G-CSF) was studied in a model of fulminant sepsis in rats. Polymicrobial peritonitis was induced by a 4 mm cecal perforation and 10 micrograms/kg recombinant human G-CSF was given intravenously every 12 h, with the first dose at sepsis induction or 4 h post-induction. Rats were sacrificed at various intervals throughout sepsis to measure levels of neutrophil progenitors in the bone marrow and neutrophils and bacteria in blood and peritoneal fluid. Sepsis gave a sustained neutropenia and bacteremia, but did not affect numbers of blast- or GM-colonies, and only a delayed and moderate proliferation of G-clones was seen. Treatment with G-CSF at sepsis induction improved myelopoiesis by doubling the numbers of GM- and G-progenitors at 12 and 24 h post-induction. Concentrations of neutrophils increased twofold in blood and 5-fold in peritoneal fluid, while bacteria counts in the same compartments declined logarithmically. Mortality was 92% in untreated sepsis and declined to 46% when G-CSF therapy was started at sepsis induction, and to 42% following 4 h delayed therapy.
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PMID:Granulocyte colony-stimulating factor improves myelopoiesis and host defense in fulminant intra-abdominal sepsis in rats. 755 81

Granulocyte colony-stimulating factor (G-CSF) stimulates the production and function of neutrophils (PMNs). Administration of G-CSF to non-neutropenic animals has been shown to improve survival in experimental models of infection, but PMNs have been implicated as mediators of acute lung injury induced by lipopolysaccharide (LPS) or bacteremia. Thus G-CSF-induced neutrophilia might be deleterious in sepsis. To investigate this possibility, we studied four groups of pigs: G+E50 (n = 6) were pretreated for 5 days with recombinant bovine (rb) G-CSF (5 micrograms/kg/day) and then challenged with LPS (50 micrograms/kg); NS+E50 (n = 6) were similarly pretreated with saline and challenged with LPS (50 micrograms/kg); E250 (n = 6) were not pretreated and were infused with a larger dose of LPS (250 micrograms/kg); RL (n = 7) were controls infused with lactated Ringer's solution. Pretreatment with rbG-CSF increased the peripheral absolute neutrophil count approximately fivefold (p < 0.05 vs. RL group). Comparisons of the NS+E50 and G+E50 groups showed that pretreatment with rhG-CSF did not affect LPS-induced alterations in mean arterial blood pressure or arterial oxygenation. Indices of pulmonary injury also were similar in these two groups, although pulmonary edema and protein leakage into alveoli were greater in the E250 group. We conclude that G-CSF-induced neutrophilia does not adversely effect physiologic responses to LPS in pigs.
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PMID:Effect of granulocyte colony-stimulating factor on systemic and pulmonary responses to endotoxin in pigs. 768 31

One hundred ten women with gynecologic malignancies underwent 116 subclavian vein Groshong catheter insertions at the bedside under local anesthesia and intravenous sedation. Three (2.6%) additional patients had unsuccessful insertions because of an inability to access the subclavian vein or thread the guidewire. Fluoroscopy was not used. There was one delayed pneumothorax and no insertion-related infections. The 111 single-lumen catheters used primarily for the administration of chemotherapy are the subject of this report. The mean age of patients was 60 (range 13 to 89) years and their average Gynecologic Oncology Group performance score was 1.1 (range, 0 to 3). Diagnoses include 74 ovarian, 19 cervical, 13 uterine, and 5 other gynecologic malignancies. Hyperalimentation was administered in 16 (14%) patients. Grade IV neutropenia occurred in 57 (51%) patients and 44 (40%) received granulocyte colony-stimulating factor during therapy. The average lifespan of catheters was 247 (range, 37 to 703) days, and 39 (35%) women died from disease with their catheter in situ at a mean time of 288 days. Thirty-seven (33%) catheters were removed after completion of chemotherapy at an average time of 239 (range, 78 to 448) days. As of 1/1/94, 22 patients continued to use their catheters at a mean of 313 (range, 182 to 509) days. The remaining 13 (11.7%) catheters were removed due to complications (7 episodes of bacteremia, 3 tunnel infections, 2 catheter migration/thromboses, and 1 catheter laceration). Twenty episodes of fever in 17 (15.3%) patients were evaluated with blood cultures in the absence of a tunnel infection. None of the 10 culture negative cases resulted in catheter removal, whereas 7 of 10 patients with bacteremia had catheters removed. Exit site infections occurred in 23 (21%) patients and were resolved with local measures and oral antibiotics. The risk of exit site cellulitis was 3.3% per month. When compared to placement of permanent central venous access devices at our institution in the operating room or radiology suite, bedside placement of Groshong catheters resulted in a savings of $1448 and $231 per case, respectively.
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PMID:An evaluation of Groshong central venous catheters on a gynecologic oncology service. 789 88

In the 1960s, almost all patients who developed gram-negative bacteremia during granulocytopenia died; death occurred before blood culture results were available in about 50% of cases; many patients received antibiotics that were, at best, suboptimal and frequently inactive against the invading pathogen. In the early 1970s epidemiological studies demonstrated that more than 50% of gram-negative bacteremias were caused by hospital-acquired strains which colonized along the alimentary canal and caused infection in a limited number of locations, especially the pharynx, lungs, colon, and perianum. Surveillance culture studies have demonstrated that among acquired gram-negative bacilli, Pseudomonas aeruginosa will almost invariably proceed to bacteremia if the patient becomes profoundly neutropenic, with Escherichia coli and Klebsiella pneumoniae leading to bacteremia in only a moderate number of patients and other gram-negative bacilli rarely progressing to bacteremia despite colonization. Hence, the leading causes of bacteremia in the granulocytopenic patient are E. coli, K. pneumoniae and P. aeruginosa. Further investigations demonstrated that gram-negative bacilli were acquired from hands, food, and water, thus leading to approaches to infection prevention which included careful handwashing, low-microbial-content diet, and attention to water sources, including ice machines. Another basic approach to infection prevention has been to suppress gram-negative bacilli colonizing the alimentary canal with oral nonabsorbable antibiotics or, more recently and more effectively, with agents such as the fluoroquinolones which, unlike previous regimens, do not concurrently suppress the anaerobic flora, hence maintaining colonization resistance. The third basic approach to infection prevention is to improve the host defense factors, principally by a more rapid return of circulating granulocytes with the use of colony-stimulating factors such as granulocyte/macrophage colony-stimulating factor or granulocyte colony-stimulating factor. As to therapy, the fundamental approach with presumed gram-negative bacteremia is the prompt institution of empiric antibiotic therapy when fever first develops in the setting of granulocytopenia. There is a short "window of opportunity" after which no therapy will be effective. Combinations of antibiotics such as a beta-lactam and an aminoglycoside are used for multiple reasons: to afford coverage in the event the pathogen, proves resistant to one of the agents, to afford a synergistic activity thus improving and prolonging the serum bactericidal activity, and to reduce the development of resistance. However, patients can be divided into two risk groups: those with granulocytopenia and a regenerating bone marrow and those with an aplastic marrow who will have persistent, profound (< 100 microliters) granulocytopenia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Gram-negative bacteremia. 814

Many chemotherapy regimens are associated with variable periods of myelosuppression. In cancer patients, neutropenia (less than 500 neutrophils/microL) is the most important risk factor for infections. The incidence and severity of infectious complications are related to depth and duration of neutropenia, with the highest risk if neutrophils are less than 100/microL for more than a week. The period required for neutrophil recovery is usually short with standard regimens, but prolonged after high dose chemotherapy followed by autologous bone marrow transplant (-ABMT) or peripheral blood stem cell (PBSC) infusion. Under these conditions, the administration of granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) accelerates neutrophil recovery and shortens the duration of hospitalization. In standard chemotherapy settings, prophylactic use of CSF's is a matter of debate. Several studies have reached contrasting conclusion, but, combining effectiveness and costs, it results that this use of CSF'S is not to be recommended unless the risk of infections (elderly patients, reduced marrow reserve) is high. The administration of G-CSF or GM-CSF to a febrile neutropenic patient (cfr CSF's therapy) shortens the duration of neutropenia, although no great clinical benefits are evident. Nevertheless the identification of subsets of patients with additional risk factors (i.e. absolute neutrophil count < 100/microL at the onset of fever or delayed neutrophil recovery) should be helpful in establishing the role of CSF's therapy. When prolonged periods of severe neutropenia (less than 500 neutrophils/microL) are expected, antibiotics should be prophylactically administered. Fluoroquinolones seem to be the optimal choice in heavily myelosuppressed patients (ie. bone marrow transplant recipients). Fluoroquinolones are effective in reducing the frequency of gram-negative bacteremia, but, because of incomplete coverage, gram-positive infections are becoming increasingly problematic. The association with an agent that can be absorbed orally, active against gram-positive cocci, seems to be an effective strategy. Fungal infections are an important cause of morbility and mortality in severely neutropenic patients. Safety and efficacy of antifungal triazoles and the lipid formulations of amphotericin B used prophylactically still require investigation. In patients at high risk for fungal infections, monitoring cultures are predictive for systemic mycoses and should guide prophylactic and therapeutic choices. The standard treatment of oncologic patients with potential infectious neutropenia complications is admission to the hospital and treatment with broad-spectrum intravenous antibiotics. Until third generation cephalosporin and carbapenems became available, most neutropenic febrile patients were treated with associations of an aminoglycoside plus a beta-lactam. Monotherapy with the new antibiotics has proven to be effective as an association therapy and offers advantages in terms of cost and tolerability. Whether or not vancomycin is included in the initial antibiotic regimen should be decided on the basis of epidemiological consideration (i.e. prevalence of meticillin-resistant Staphylococcus aureus or Staphylococcus mitis in certain centers). Antifungal therapy is indicated in neutropenic patients who remain febrile after one week of broad-spectrum antibiotics or have recurrent fever. Amphotericin B should be promptly administered in patients suspected of invasive mycoses. Selected patients with fever and neutropenia, that can be identified on the basis of reduced risk of severe complications, do not need hospitalization. In the first reports, outpatient treatment has proven to be effective, cost saving and well received by patients, but further studies are needed to accurately define low risk status and the optimal home antibiotic regimens.
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PMID:[Prevention and treatment of febrile neutropenia]. 923 24

Acute respiratory failure (ARF) occurred at the time of leukocyte recovery promoted by granulocyte colony-stimulating factor (G-CSF) in three patients with the preceding infection (S. aureus pneumonia, varicella zoster, and P. aeruginosa bacteremia, respectively) which had developed during leukopenia after cancer chemotherapy. G-CSF was used for 4 to 6 days, and the leukocyte counts at onset of ARF were 19,300/microliter, 11,300/microliter, and 4,100/microliter, respectively. All of the three patients received high-dose methylprednisolone and the artificial respiration was used in two. Consequently two patients responded well and survived, but one died of respiratory failure 2 weeks after occurrence of ARF. Autopsy of the dead case revealed mild interstitial pneumonia in the both lungs together with bacterial pneumonia in the right lobe. These cases indicate that G-CSF-induced leukocyte recovery can cause severe ARF in patients with precending infection. Therefore, G-CSF should be administered very carefully to granulocytopenic patients with infection.
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PMID:[Acute respiratory failure associated with G-CSF-induced leukocyte recovery in three patients with preceding infection]. 939 63


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