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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The exact timing of the introduction of the glycopeptide antibiotics teicoplanin and vancomycin in the management of the febrile neutropenic patient continues to be controversial. However, there are certain firm criteria now emerging. Bacteraemia can be eradicated with a success rate approaching 100% in cases where the organism can be identified and shown to be sensitive. Approximately 65% of cases of soft-tissue infection, usually occurring with the use of a Hickman or equivalent indwelling catheter, are associated with the presence on culture of Gram-positive organisms of presumed skin origin. Such infection is an indication for the early use of antibiotics with proven activity against coagulase-negative staphylococci and diptheroids. Resolution of fever in up to 50% of cases may result from using 'planned progressive therapy': the introduction of specific Gram-positive cover in patients who have failed to respond at 48-72 h to regimens such as a ureidopenicillin or a third-generation cephalosporin with or without an aminoglycoside. This approach reduces the number of patients who go on to receive empirical amphotericin B intravenously for presumed fungal infection. Using teicoplanin or vancomycin as first-line agents in the empirical treatment of first fever in febrile neutropenic patients is perhaps more controversial. Recent developments which include using quinolone-based prophylaxis more widely and introducing cytokines to reduce the period of neutropenia may increase the likelihood that a neutropenic patient's febrile episode will be due to a Gram-positive organism. The dilemma of choosing broad-spectrum monotherapy or targeted combination therapy in the situation remains unresolved. Current studies, however, should help to clarify this situation. Finally, other current studies of teicoplanin and vancomycin as prophylactic agents administered either orally or systemically, may provide additional indications for their use in the neutropenic patient.
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PMID:Role of glycopeptide antibiotics in the treatment of febrile neutropenic patients. 214 54

Aspiration or ingestion of contaminated amniotic fluid or vaginal secretions has been suggested as a cause of systemic group B streptococcal (GBS) infection in the neonate. Suckling rat studies disagree on whether systemic disease will develop after an oral challenge of GBS. Our goal was to determine if systemic GBS disease would occur following oral colonization in the suckling rat and the effect of bacterial, host and environmental factors. Suckling rat littermates received oral inoculation on one of the first four days of life with varying doses and strains of GBS. Studies confirmed gastric inoculation without aspiration. Mortality and bacteremia decreased with age, increased with dose, varied with strain, and increased with asphyxia. Autopsy confirmed sepsis, intestinal colonization, meningitis, and pneumonia. Bacteremia was associated with an abnormal immature: total neutrophil ratio at 24 hr, thrombocytopenia at 48 hr, and neutropenia at 72 hr after inoculation. GBS can cause systemic infection in the host after oral colonization which appears age-, dose, strain-, and environment-dependent. Evaluation of GBS entry in the susceptible host may facilitate therapies directed toward preventing mucosal invasion.
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PMID:Systemic group B streptococcal disease in the neonate: characterization of an oral colonization model using the suckling rat. 214 5

Five patients undergoing transplantation of autologous bone marrow underwent percutaneous placement of a double lumen central venous catheter into the inferior vena cava by way of the femoral vein. All had conditions that precluded access to the superior vena cava or other sites in the upper part of the torso. Patients ranged in age from 18 to 59 years. The double lumen central venous catheter was inserted using aseptic technique in the operating room, and the catheter exit site was dressed using sterile technique every 48 hours afterward. Patients received all irradiated blood product transfusions, intravenous fluids, intravenous antibiotics, parenteral alimentation and autologous bone marrow reinfusion through the catheter. The duration of severe neutropenia (less than 500 neutrophils per microliter) and severe thrombocytopenia (less than 20,000 platelets per microliter) ranged from zero to 24 days (median of 22 days) and five to 20 days (median of 15 days), respectively. Catheters remained in the groin area 23 to 45 days (median of 35 days). Complications included one catheter-related Streptococcus species infection and one Escherichi coli bacteremia. These infections resolved with the catheter in place after appropriate institution of antibiotics. No episodes of thrombosis, kinking, migration, extravasation of drugs or local infection were noted. Central venous catheters can be safely inserted and maintained in the groin area even in severely immunocompromised patients receiving bone marrow transplants.
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PMID:Percutaneous placement of femoral central venous catheter in patients undergoing transplantation of bone marrow. 218 72

During the last two decades the mortality from gram-negative septicemia in neutropenia patients with serious underlying disease has declined from 85% to less than 20%. Many factors seem responsible for this trend: (a) the development of potent broad-spectrum antimicrobial agents (b) aggressive clinical approaches to empiric therapy entailing the use of antibiotics before results of cultures are known. (c) better supportive care, (d) improved treatment of underlying disease. Controversy persists about the choice of "optimum" regimens: clinical studies to date show major differences in evaluation criteria, particularly in the definition of "response". The largest and most convincing studies of gram-negative bacteremia still favor the use of antibiotic combinations in patients with profound, persistent neutropenia.
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PMID:Neutropenia: antibiotic combinations for empiric therapy. 249 91

Considerable changes have occurred during the 1980s in the clinical nature and diagnosis of bacteremia and fungemia in the immunocompromised patient. Cancer patients with prolonged neutropenia, many with indwelling catheters, and AIDS patients with both T-cell and B-cell deficiencies have changed the spectrum of organisms causing septicemia. There has been a shift to infection with gram-positive bacteria, including mycobacteria, and water-borne organisms, including Acinetobacter spp. and Pseudomonas spp. New blood culture systems, including a lysis-centrifugation system and radiometric methods utilizing resin broth media, remove antagonistic antimicrobial agents, and the lysis-centrifugation system routinely provides quantitation of organisms from the blood. Quantitation has been used to identify sources of infection, to differentiate contamination from true infection, and to monitor the course of antibiotic treatment.
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PMID:Bacteremia and fungemia in the immunocompromised patient. 251 58

A review of consecutive previously healthy children with fever and newly discovered neutropenia without underlying malignancy, evaluated during a three-year period, was performed. A total of 68 episodes occurred in 68 patients; blood culture was performed on each. Of 17 patients who appeared compromised (ill, irritable, toxic) on presentation, five (30%) had either bacteremia or bacterial meningitis. All five patients had clinical evidence of a fulminant disease process on examination. By contrast, all 51 patients who appeared to be well on presentation were culture-negative. Fever and new-onset neutropenia in children is a heterogeneous disorder with several outcomes. Any child with fever and newly discovered neutropenia who appears ill should be presumed to be at high risk for systemic bacterial infection and receive hospitalization for parenteral antibiotic therapy. By contrast, the previously healthy child older than two months of age with fever and new-onset neutropenia who appears to be well, and whose clinical evaluation does not indicate a serious underlying disease process, is at low risk for accompanying systemic bacterial infection; hospitalization with empiric antibiotic therapy pending culture results is not warranted for the majority of such children. Close outpatient monitoring with serial evaluation of the peripheral blood absolute neutrophil count to document bone marrow recovery is recommended for such cases.
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PMID:Clinical characteristics of children with fever and transient neutropenia who experience serious bacterial infections. 260 44

Disruption of the oral mucosal lining and the lack of normal defense mechanisms predispose bone marrow transplant (BMT) patients to life-threatening infections, often caused by oral flora. Chlorhexidine, used as an oral antiseptic, appears promising in limiting oral bacteria and fungi, and therefore, may decrease oral complications associated with BMT. The purpose of this study was to determine in pediatric BMT recipients if a 0.12% chlorhexidine mouthrinse, used as an adjunct to normal in-hospital oral care regimens, would decrease the severity of oral mucositis as measured by oral ulcerations, bacteremia, and length of hospital stay. Forty-seven pediatric BMT subjects were included in this double-blind study. Subjects were instructed to use 15 ml of a mouthrinse 3 times daily to be swished and gargled for 30 sec. Each subject had 7 oral sites scored for the percentage of ulcerated mucosa twice weekly until day +35 or hospital discharge or death. Blood was cultured daily during neutropenia. Additionally, the number of days from onset of cytoreduction to hospital discharge or death was recorded for each subject. Alpha was set at .05. There was no significant difference in the severity of oral ulceration between the chlorhexidine and placebo groups (P = .18). Chlorhexidine did not reduce the development of bacteremia (P greater than .5), nor did it significantly decrease the length of hospital stay (P = .68).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population. 262 38

A review was performed of the 57 cases of Klebsiella pneumoniae bacteremia that occurred in children at our institution during a 10-year period. The rate of K pneumoniae bacteremia relative to all blood cultures in which bacteria were isolated was 1.1%. Children younger than 12 months of age accounted for 38 cases (67%). There were 8 children (14%) who were afebrile at the time bacteremia was documented; other presenting clinical features were generally indistinguishable from those that characterize pediatric bacteremia of more common causes. Fourteen children (25%) were receiving broad-spectrum parenteral antibiotic therapy at the time bacteremia was documented. In 53 patients (93%), an underlying condition predisposing to opportunistic infection was identified, the most common of which were lesions of the gastrointestinal tract (56%), presence of an indwelling central venous catheter (35%), and neutropenia (25%). Klebsiella pneumoniae was a constituent of polymicrobial bacteremia in 15 patients (26%). The overall mortality rate associated with this infection was 20%, with over one half of all deaths occurring in infants who were afebrile at the time bacteremia was documented. Klebsiella pneumoniae bacteremia is a relatively uncommon, serious infection that usually occurs in young children with predisposing underlying conditions, and is associated with a significant mortality rate.
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PMID:Klebsiella pneumoniae bacteremia in children. Fifty-seven cases in 10 years. 267 84

Twenty-six episodes of Pseudomonas aeruginosa bacteremia treated with intravenous ceftazidime, 4-6 g/day were evaluated. Treatment was begun within the first 24 hours after the isolation of the microorganism and was maintained for 10-12 days. In two patients with neutropenia amikacin was added during the initial 48-72 hours until the susceptibility to ceftazidime was known. All isolates were sensitive to ceftazidime. The most common underlying diseases were neoplasia (12), diabetes with stroke (4), neurosurgical and vascular procedures (4), rheumatoid arthritis (2), burns (2), cor pulmonale (1), and hypertension (1). The origins of bacteremia were urinary (12), pulmonary (9), and unknown (5). The infection was hospital-acquired in 77% and community-acquired in 23%. A critical clinical status and the presence of complications were significantly (p less than 0.01) associated with an increased mortality rate. Clinical outcome was good in 18/26 (70%), with a 30% mortality rate. The microbiological evolution showed 14 eradications, 6 persistences, 3 relapses and 3 colonizations. Resistance did not develop during therapy. Ceftazidime may be a good alternative therapy for these severe infections, although wider comparative studies are required for a better evaluation.
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PMID:[Evaluation of ceftazidime monotherapy in Pseudomonas aeruginosa bacteremias. Prospective study]. 268 60

In a multicenter, randomized clinical trial, the efficacy of ciprofloxacin plus azlocillin was compared with that of a standard regimen of ceftazidime plus amikacin for the initial empiric treatment of fever in neutropenic cancer patients. In addition, the efficacy of early conversion from intravenous therapy to orally administered ciprofloxacin was compared with that of continued ceftazidime plus amikacin. Seventy-one oncology patients with 79 episodes of fever and neutropenia were randomly assigned to receive initial empiric antibiotic therapy with either intravenously administered ciprofloxacin and azlocillin followed by orally administered ciprofloxacin (regimen 1, 25 episodes); ceftazidime and amikacin (regimen 2, 30 episodes); or ceftazidime and amikacin followed by oral ciprofloxacin (regimen 3, 24 episodes). Microbiologically documented infections were the cause of fever in 10 (40 percent), seven (23 percent), and nine (38 percent) episodes in regimens 1, 2, and 3, respectively, including six, five, and four episodes of bacteremia. Patient survival was 90 to 92 percent in each regimen; however, some modification of antimicrobial therapy occurred in 65, 44, and 41 percent of surviving patients in regimens 1, 2, and 3, respectively. The rate of clearance of initial bacteremia was 67 percent (four of six) in regimen 1, 100 percent (five of five) in regimen 2 and 50 percent (two of four) in regimen 3. Patients in regimens 1 and 3 were able to convert to orally administered ciprofloxacin in 32 (65 percent) of 49 episodes after a mean of six days of intravenous therapy. Superinfections occurred in 24, 10, and 12 percent of patients receiving regimens 1, 2, and 3, respectively, and occurred similarly for patients receiving orally administered ciprofloxacin, 12 percent (four of 32), and intravenous therapy, 17 percent (eight of 47). Parenteral ciprofloxacin was generally well tolerated. One (4 percent) of 25 patients receiving regimen 1 experienced oto- or nephrotoxicity, compared with eight (15 percent) of 54 patients receiving regimens 1, 2, and 3 (p = 0.15), including three patients who required premature termination of aminoglycoside therapy. Our data suggest that the combination of ciprofloxacin and azlocillin is an effective alternative to ceftazidime and amikacin for the initial empiric therapy of febrile neutropenic patients, is generally well tolerated, and avoids the oto- and nephrotoxicity associated with aminoglycoside use. In addition, a majority of patients could change to orally administered ciprofloxacin alone after six days of parenteral therapy.
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PMID:Multicenter, randomized trial of ciprofloxacin plus azlocillin versus ceftazidime plus amikacin for empiric treatment of febrile neutropenic patients. 268 29


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