scholarly journals Extended vs Bolus Infusion of Broad-Spectrum β-Lactams for Febrile Neutropenia: An Unblinded, Randomized Trial

2018 ◽  
Vol 67 (8) ◽  
pp. 1153-1160 ◽  
Author(s):  
Ron Ram ◽  
Yael Halavy ◽  
Odelia Amit ◽  
Yael Paran ◽  
Eugene Katchman ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Randomized Trial ◽  
Broad Spectrum ◽  
Bolus Infusion

scholarly journals Chryseobacterium indologenes as a Rare Pathogen of Bacteremia in Febrile Neutropenia

2021 ◽  
Author(s):  
Begümhan Demir Gündoğan ◽  
Fatih Sağcan ◽  
Elvan Çağlar Çıtak
Keyword(s):  
Risk Factors ◽  
Febrile Neutropenia ◽  
Broad Spectrum ◽  
Antimicrobial Susceptibility ◽  
Neutropenic Fever ◽  
Susceptibility Test ◽  
Antimicrobial Susceptibility Test ◽  
Gram Negative ◽  
Chryseobacterium Indologenes ◽  
Test Result

Chryseobacterium indologenes (C. indologenes) is nonmotile, oxidase-, and indole-positive gram-negative aerobic bacillus. Immunosuppression, comorbidities, use of broad-spectrum antibiotics are known risk factors for C. indologenes-related infections. We report a neutropenic fever caused by C. indologenes in a 16-month-old boy who was treated due to the neuroblastoma. According to the antimicrobial susceptibility test result, he was treated with cephaperazone/sulbactam.

scholarly journals O12 Circulating concentrations of broad-spectrum beta-lactams in children with cancer: beware of glomerular hyperfiltration!

2019 ◽  
Vol 104 (6) ◽  
pp. e5.2-e6
Author(s):  
P André ◽  
L Diezi ◽  
LA Decosterd ◽  
PA Crisinel ◽  
K Dao ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Broad Spectrum ◽  
Large Fraction ◽  
Glomerular Hyperfiltration ◽  
List Type ◽  
Beta Lactams ◽  
Children With Cancer ◽  
Therapeutic Success ◽  
The Impact ◽  
Trough Levels

BackgroundBroad-spectrum beta-lactams such as meropenem (MER) and piperacillin-tazobactam (PIP) are commonly prescribed in children with cancer having febrile neutropenia. They are introduced at intensive dosage, unless decreased renal function calls for dose reduction. Recently, glomerular hyperfiltration (HF) was recognized to be frequent among children with cancer during initial cycles of chemotherapy.1 We evaluated the impact of HF on therapeutic exposure to MER and PIP.MethodsWe retrieved retrospectively all MER and PIP plasma levels measured in children with cancer in our hospital between 2012 and 2018. We compared trough levels with usual therapeutic ranges (derived from reference values of minimum inhibitory concentrations). We classified the children according to plasma creatinine and estimated glomerular filtration rate (Schwartz formula) as either altered-normal (< 160 mL/min/1.73 m2) or increased (i.e. HF, ≥160). Neutropenia was defined as absolute neutrophil count < 500 cells/µL.ResultsWe collected 120 concentration values (53 MER, 67 PIP) measured in 50 children with cancer. Among them, 74 (62%) had concomitant creatinine values suggestive of HF, and 80 (67%) were neutropenic. Overall, 67% of trough levels were below usual therapeutic ranges (MER: 2–8 mg/L, PIP 8–30 mg/L). This was more often the case in presence of concomitant HF (MER: 92%, PIP: 83%), often associated with neutropenia. Low exposure was observed not only at initial intensive dosage (MER: 120 mg/kg/day, PIP: 400 mg/kg/day)2 but tended to persist despite dosage readjustment based on concentration monitoring. Moreover, bacteremia was diagnosed in 38 cases.ConclusionCurrent recommended doses of MER and PIP do not provide optimal concentration coverage throughout the dosing interval in a large fraction of children with cancer and febrile neutropenia as a result of HF. Monitoring of beta-lactams should be offered to all children with cancer to ensure best therapeutic success and avoid the development of resistance.ReferencesKwatra NS, Meany HJ, Ghelani SJ, Zahavi D, Pandya N, Majd M. Glomerular hyperfiltration in children with cancer: prevalence and a hypothesis. Pediatr Radiol 2017;47(2):221–226.The Lexicomp Pediatric & Neonatal Dosage Handbook, 21st edition, Lexicomp, USA.Disclosure(s)Nothing to disclose

Antimicrobial de-escalation in adult hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin

2019 ◽  
Vol 26 (3) ◽  
pp. 632-640 ◽  
Author(s):  
Megan M Petteys ◽  
Ekaterina Kachur ◽  
Kelly E Pillinger ◽  
Jiaxian He ◽  
Edward A Copelan ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Cell Transplantation ◽  
Broad Spectrum ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hematopoietic Cell Transplantation ◽  
Unknown Origin ◽  
Hematopoietic Cell ◽  
Hematopoietic Recovery ◽  
Haploidentical Hematopoietic Cell Transplantation

Background The optimal duration of empiric antimicrobial therapy in febrile neutropenia of unknown origin is unclear. This study evaluated outcomes in autologous and allogeneic hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin who received early de-escalation of broad-spectrum antimicrobials prior to hematopoietic recovery versus those who continued broad-spectrum antimicrobials until hematopoietic recovery. Methods A single-center, retrospective study assessed hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin. Patients were categorized into either cohort 1, representing early de-escalation prior to hematopoietic recovery, or cohort 2, representing continuation of broad-spectrum antimicrobials until hematopoietic recovery. Results A total of 107 patients were included (22.4% in cohort 1 and 77.6% in cohort 2). Most patients (87.5%) in cohort 1 underwent haploidentical hematopoietic cell transplantation, whereas 84.3% of patients in cohort 2 received autologous hematopoietic cell transplantation. There were no significant differences in rates of recurrent fever (4.2% versus 7.2%, in cohorts 1 and 2, respectively, adjusted odds ratio = 0.84, P = 0.85), re-escalation (4.2% versus 4.8%, adjusted odds ratio = 1.57, P = 0.64), and Clostridioides difficile-associated infections (4.2% versus 2.4%, adjusted odds ratio = 2.27, P = 0.43). No patient experienced in-hospital mortality, intensive care unit admission, or bacteremia. Conclusion Hematopoietic cell transplantation recipients with febrile neutropenia of unknown origin in which broad-spectrum antimicrobials were de-escalated prior to hematopoietic recovery did not experience adverse outcomes. These results concur with recently published studies and the Fourth European Conference on Infections in Leukemia guidelines. An early de-escalation approach in haploidentical hematopoietic cell transplantation recipients specifically appears safe and may result in a reduction in antimicrobial utilization.

scholarly journals An empirical broad spectrum antibiotic therapy in health-care-associated infections improves survival in patients with cirrhosis: A randomized trial

Hepatology ◽  
2016 ◽  
Vol 63 (5) ◽  
pp. 1632-1639 ◽  
Author(s):  
Manuela Merli ◽  
Cristina Lucidi ◽  
Vincenza Di Gregorio ◽  
Barbara Lattanzi ◽  
Valerio Giannelli ◽  
...  
Keyword(s):  
Health Care ◽  
Antibiotic Therapy ◽  
Randomized Trial ◽  
Broad Spectrum ◽  
Broad Spectrum Antibiotic ◽  
Health Care Associated Infections

scholarly journals 2187. Prediction of Patient Outcome During Febrile Neutropenia Despite Anti-infective Treatment Using Machine Learning Algorithms

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S744-S744
Author(s):  
Carolin Jakob ◽  
Annika Classen ◽  
Melanie Stecher ◽  
Sandra Fuhrmann ◽  
Bernd Franke ◽  
...  
Keyword(s):  
Machine Learning ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Broad Spectrum ◽  
Medical Data ◽  
Adverse Outcomes ◽  
Supervised Machine Learning ◽  
Resistant Bacteria ◽  
Validation Data ◽  
Data Set

Abstract Background Clinical management of prolonged febrile neutropenia despite broad-spectrum empirical antibacterial treatment is a clinical challenge, as standard empirical treatment has failed and a broad spectrum of differential diagnoses has to be considered. Growing prevalence of multi-resistant bacteria and fungi has made a balanced choice of effective anti-infective treatment more difficult. A reliable prediction of complications could indicate options for treatment optimization. Methods We implemented a supervised machine learning approach to predict death or admission to intensive care unit within 28 days in cancer patients with prolonged febrile neutropenia (neutrophils < 500/mm3 and body temperature ≥ 38°C longer than 3 days). We analyzed highly granular retrospective medical data of the Cologne Cohort of Neutropenic Patients (CoCoNut) between 2008 and 2014. Random forest and 10-fold cross-validation were used for classification. The neutropenic episodes from 2014 were used for evaluation of prediction. Results In total, 927 episodes of prolonged febrile neutropenia (median age 52 years, interquartile range 42–62; 562/927 [61%] male; 390/927 [42%] acute myeloid leukemia; 297/927 [32%] lymphoma) with 211/927 (23%) adverse outcomes were processed. We computed 226 features including patient characteristics, medication, clinical signs, as well as laboratory results describing changes of state and interactions of medical parameters. Feature selection revealed 65 features with an area under the receiver operating characteristic curve (AUC) of 0.75. In the validation data set the optimized model had a sensitivity/specificity of 36% and 99% (AUC: 0.68; misclassification error: 0.12) and positive/negative predictive values of 89% and 88%, respectively. The most important features were albumin, age, and procalcitonin. Conclusion Structured granular medical data and machine learning approaches are an innovative tool that can be used in a retrospective setting for prediction of adverse outcomes in patients with prolonged febrile neutropenia. This study is the first important step toward clinical decision support based on predictive models in high-risk cancer patients. Disclosures All authors: No reported disclosures.

Does home antibiotic therapy increase medical risk for patients with low-risk febrile neutropenia? A multi-institutional randomized trial

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 8113-8113
Author(s):  
J. A. Talcott ◽  
B. Yeap ◽  
P. A. Godley ◽  
C. Lu ◽  
R. D. Siegel ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Antibiotic Therapy ◽  
Randomized Trial ◽  
Low Risk ◽  
Medical Risk
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