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

The usefulness of determining serum levels of C-reactive protein (CRP) for the identification of bacterial infections in febrile neutropenic patients with cancer was evaluated. Two hundred children with cancer were monitored prospectively for the occurrence of neutropenia and fever; serum was collected from these children for determining baseline levels of CRP. Of these 200 children, 75 had 85 febrile neutropenic episodes; serum was collected daily from these 75 children for CRP analysis by nephelometry. Children were included into one of the three following groups by physicians blinded to results of CRP analysis: group I, demonstrated bacterial infection (24 episodes); group II, probable bacterial infection (31 episodes); and group III, viral infection or no infection (30 episodes). Baseline CRP values were low (mean, 9 mg/L; range, 0-35 mg/L) irrespective of tumor type or stage of therapy. Mean CRP values on day 1 for children in groups I and II (194 and 143 mg/L, respectively) were higher than those for children in group III (29 mg/L) (P < .001). A CRP value of > 40 mg/L discriminated children with a demonstrated bacterial infection (sensitivity, 100%; specificity, 76.6%). Children with an unfavorable outcome had persistently high levels of serum CRP. For children with cancer, neutropenia, and fever, determination of the serum CRP level is useful for early diagnosis of bacterial infections and for monitoring the course of infection.
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PMID:C-reactive protein: a valuable aid for the management of febrile children with cancer and neutropenia. 803 14

We conducted a non-randomized, prospective study comparing the efficacy of tosulfloxacin with that of norfloxacin in preventing bacterial infection during chemotherapy-induced neutropenic episode. Fifty-one patients with hematological malignancies were included, and a total of 108 episodes of neutropenia were studied. There was no significant difference between the two groups in the incidence of fever, in the time-to-event analysis of febrile episodes nor in the incidence of gram-positive bacteremia despite the broader spectrum of tosulfloxacin. The incidence of gram-negative bacteremia was lower in patients treated with the quinolones as a prophylactic than in the historical controls given polymyxin B. Especially the incidence of bacteremia due to Pseudomonas aeruginosa was significantly less when tosulfloxacin was used. A possible synergistic effect of sulfamethoxazole-trimethoprim in preventing the febrile episode was also observed.
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PMID:Tosulfloxacin versus norfloxacin for prevention of infections in chemotherapy-induced neutropenic patients. 808 54

Depletion neutropenia caused by overwhelming bacterial infection is associated with fatal outcome and is an objective indicator of the severity of sepsis. Studies on controlled evaluation of exchange transfusion in the management of severe neonatal sepsis have not considered neutropenia as an inclusion criterion, and randomized, controlled trials on evaluation of neutrophil functions after exchange transfusion are scarce. This prompted us to carry out the present study. Septicemic neonates were enrolled if they had neutropenia and were randomized to undergo exchange transfusion (study group, n = 20) or not (controls, n = 10). Granulocyte functions were assessed using the nitro blue tetrazolium (NBT) reduction test and the staphylococcidal index. Blood was drawn for granulocyte function tests once from controls and donors, and before, immediately after and 6 h after exchange transfusion in the study group. Mortality was 35% in the study group and 70% in controls. Gram-negative organisms accounted for 80% in the study group and 90% in controls. Mean total leukocyte count and neutrophil count increased significantly immediately after exchange transfusion and 6 h later. Absolute band count decreased significantly immediately after exchange transfusion and increased 6 h later. NBT reduction in septicemic neonates in the study group, as well as in controls, was significantly decreased as compared to donor cells. NBT reduction improved significantly immediately after exchange transfusion and 6 h later. The values of the percentage of viable staphylococci recovered from neutrophils also improved significantly immediately after exchange transfusion and 6 h later.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions. 811 Nov 74

Fluoroquinolone prophylaxis in patients with profound neutropenia may be useful for preventing gram-negative bacterial infection, but it is ineffective against gram-positive bacterial infections in the bloodstream, particularly those caused by streptococci and coagulase-negative staphylococci, which appear to have emerged as significant causes of morbidity, decreased treatment efficacy, and the increased costs of empiric antimicrobial therapy. In a prospective, randomized, open trial, we evaluated the efficacy and safety of oral roxithromycin (150 mg twice daily) as additional antibacterial prophylaxis in 131 adult patients with acute leukemia and bone marrow transplant recipients receiving oral ofloxacin. In comparison with patients given ofloxacin alone, fewer patients receiving ofloxacin plus roxithromycin developed bacteremia caused by viridans group streptococci (incidence, 9 versus 0%; P = 0.03), while the incidence of bacteremia caused by other organisms, the incidence of febrile episodes from any cause, the risk of infection-associated complications (including prolonged or secondary fever, pneumonia, septic shock, need for mechanical ventilation, and/or infection-related death), and antimicrobial usage for therapy were comparable between both groups. Adverse events possibly related to the study drugs were slightly more common among the patients receiving the combination treatment (P = 0.05). Although effective for the prevention of streptococcal bacteremia, the addition of roxithromycin to a fluoroquinolone should not be used routinely as a prophylactic regimen in patients with profound neutropenia, but it might be considered and may be useful for cancer patients with a particularly high risk of streptococcal infection and related complications.
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PMID:A randomized trial of roxithromycin in patients with acute leukemia and bone marrow transplant recipients receiving fluoroquinolone prophylaxis. 820 38

Candida sepsis is a serious and ever increasing complication in patients with a reduced defense capacity. At the intensive care unit of the infectious department in 1978-1990 from a total of 430 patients with the diagnosis of sepsis 20 (4.7%) had a Candida aetiology. Candida sepsis is suspected in particular in leukaemic patients with neutropenia, in organ transplantations and in patients given intensive care on account of a serious primary disease, bacterial infection or after surgery. The risk of deep candidosis is increased by venous catheters, hyperalimentation, antibiotic treatment, invasive operations. Diagnosis is supported by endophthalmitis and skin lesions; signs of affection of the liver, lungs, kidneys and cardiac valves are sought. Analysis of risk factors, pathogenesis and the clinical picture of invasive Candida infections is based on ample data in the literature.
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PMID:[Candida sepsis. I. Risk factors, pathogenesis and the clinical picture]. 837 50

The safety of piperacillin/tazobactam was investigated in Phase I and Phase III clinical studies. In 22 Phase I pharmacokinetic studies, 242 healthy subjects and 232 patients were given single and multiple doses of piperacillin/tazobactam, piperacillin alone, tazobactam alone, and/or placebo. Interaction with tobramycin and vancomycin was also studied. Of 1201 patients enrolled in Phase III trials, 944 received piperacillin 4 g plus tazobactam 500 mg every 8 h for lower respiratory tract infections, complicated urinary tract infections, skin and soft tissue infections, and intra-abdominal infections, or piperacillin 2 g plus tazobactam 500 mg 8 hourly for less severe infections; 90 patients received imipenem/cilastatin as a comparative regimen. Piperacillin 4 g and tazobactam 500 mg were also administered every 6 h with an aminoglycoside to 167 patients with pulmonary infection or neutropenia and bacterial infection. In all trials, piperacillin/tazobactam was found to be safe and well tolerated. One death was deemed possibly drug-related. Thirty-eight patients were withdrawn from the trials because of adverse experiences, most often diarrhoea and allergic skin reactions. The commonest laboratory abnormalities related to liver function. The safety of piperacillin/tazobactam appears similar to that of other beta-lactam/beta-lactamase inhibitor combinations.
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PMID:Safety profile of piperacillin/tazobactam in phase I and III clinical studies. 838 52

Bacterial complications develop mainly after transplantation during the period before engraftment takes place. Wound infections, urinary tract infection and pneumonia are the commonest complications of solid organ transplantation and generally involve Gram-negative bacilli and Staphylococcus aureus. However, Gram-positive cocci will predominate when selective oral antimicrobial prophylaxis is given as is frequently the case in bone marrow transplant recipients. Oromucositis, induced by total body irradiation or anthracyclines, result in more bacteraemia due to oral viridans streptococci. The use of central intravenous catheters leads to an increase in bacteraemia and infection due to coagulase-negative staphylococci. Patients requiring intensive care are also at risk of nosocomial infections including legionellosis. Once engraftment has occurred, there is much less risk of bacterial infection but patients remain vulnerable to the intracellular pathogens Listeria monocytogenes, non-typhoid salmonellae, Norcardia spp. and mycobacteria for as long as they require immunosuppression. Any rejection crisis must be treated aggressively with high-dose steroids or other agents which further undermine an already fragile immunity. In bone marrow transplant recipients, graft versus host disease and its treatment exerts a more profound effect on immunity and often coincides with cytomegalovirus infection which compromises the patient even further. Such patients are again at risk of infection with the same range of pathogens encountered during neutropenia since the oral mucosa, gut and catheter, if one is present, provide the same portals of entry. Immunosuppressive therapy, in some centres, is discontinued once the risk of graft versus host disease is reduced, although the reconstitution of the immune system is a lengthy process and there is a continued deficiency of IgG which renders patients unable to opsonise the encapsulated bacteria Streptococcus pneumonia and Haemophilus influenzae. In contrast to bone marrow transplant recipients, those with a solid organ transplant require life-long immunosuppression and so remain susceptible to infections with intracellular pathogens and, even with minimal immunosuppression, there will always be the risk that common bacteria will cause infection in unusual places and that uncommon organisms will be involved in apparently straightforward infections.
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PMID:Bacterial complications of transplantation: diagnosis and treatment. 860 44

Bacterial infections are common in persons with symptomatic disease caused by human immunodeficiency virus (HIV). Colonisation and infection with Staphylococcus aureus is present in 30% to 50% of persons with HIV disease. Risk factors for bacteraemia due to S. aureus include nasal colonisation, advanced HIV disease with CD4+ lymphocyte count < 100/mm3, prior hospitalisations, neutropenia, skin lesions, intravenous drug use, and the presence of invasive devices, such as intravenous catheters. Some antibiotics may increase the risk of S. aureus nasal colonisation, and others such as trimethoprim-sulphamethoxazole and rifabutin may reduce colonisation and disease. Preliminary data suggest that mupirocin may decrease nasal colonisation with S. aureus, but the optimal regimen, duration of effect, use, and concerns about resistance, need further evaluation. Recent data suggest that bacterial infection may accelerate the progression of HIV disease. The presence of bacterial superantigens or cytokines, such as the exotoxins present in many strains of S. aureus have been shown to induce HIV production in human peripheral blood mononuclear leukocyte cultures in vitro, although the precise mechanism is unclear. Thus, HIV infection may increase the risk of S. aureus colonisation and disease and, in turn, infection or colonisation with S. aureus may accelerate the progression of HIV disease to AIDS.
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PMID:Staphylococcus aureus colonisation and bacteraemia in persons infected with human immunodeficiency virus: a dynamic interaction with the host. 860 35

Vibrio vulnificus is an estuarine bacterium that causes septicemia and serious wound infection. Cytolysin produced by V. vulnificus has been incriminated as one of the important virulence determinants of bacterial infection. Cytolysin (8 hemolytic units) given intravenously to mice via their tail veins caused severe hemoconcentration and lethality. Cytolysin treatment greatly increased pulmonary wet weight and vascular permeability as measured by (125)I-labeled albumin leakage without affecting those factors of other organs significantly. Blood neutrophils were markedly decreased in number after cytolysin injection, with a concomitant increase in the level of pulmonary myeloperoxidase activity, indicating that cytolysin-induced neutropenia might be due to pulmonary sequestration of neutrophils. By microscopic examination, severe perivascular edema and neutrophil infiltration were evident in lung tissues. These results suggest that increased vascular permeability and neutrophil sequestration in the lungs are important factors in lethal activity by cytolysin.
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PMID:Pulmonary damage by Vibrio vulnificus cytolysin. 911 7

We have reviewed the records of all patients who were included in EORTC-IATCG protocols for the empirical treatment of febrile neutropenia at the Institut Jules Bordet from 1984 to 1994. Of the 410 granulocytopenic patients, 49 died during or after febrile neutropenia. Among these, 19 died from infection, 18 from progressive neoplasia, and 12 from other causes. Fatal bacterial infection occurred in 10 patients and arose during the first 10 days; fatal fungal infection occurred in 7 patients, all of whom had a profound and protracted granulocytopenia (polymorphoneutrophil count < 100/mm3 for more than 20 days). In comparison with a previous similar study (1974-1983) our present observations shows a decrease of overall mortality during or after febrile neutropenia and an increase of gram-positive microorganisms and fungal pathogens as a cause for infectious deaths.
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PMID:Initial empirical antibiotic therapy for neutropenic fever: analysis of the causes of death. 873 54


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