scholarly journals Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies

2017 ◽  
Vol 11 (07) ◽  
pp. 521-526
Author(s):  
Seyit Ali Büyüktuna ◽  
Rabin Saba ◽  
Mustafa Gökhan Gözel ◽  
Özge Turhan ◽  
Dilara İnan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Survival Rates ◽  
Underlying Disease ◽  
Salvage Chemotherapy ◽  
Cytotoxic Chemotherapy ◽  
Secondary Infections ◽  
Neutropenic Patients ◽  
Neutropenic Episode

Introduction: This study was initiated to investigate the risk factors of secondary infections in febrile neutropenic patients following chemotherapy, and to evaluate the clinical, microbiological, and mortality outcomes of these infections. Methodology: An evaluation was done on all patients with hematological malignancy who developed a febrile neutropenic episode (FNE) after cytotoxic chemotherapy in the Department of Hematology, Akdeniz University Faculty of Medicine, between January 2007 and December 2008. Results: A total of 294 primary FNEs that responded to the initial empirical or targeted treatment were included in the study, and secondary infections developed after 72 (24.5%) of 294 primary FNEs. Risk factors for secondary infections were determined as acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, prolonged neutropenia (10 days and over), Multinational Association of Supportive Care in Cancer (MASSC) score < 21, and fungal infection during the primary episode. The mortality rate of patients who developed secondary infections was significantly higher compared to patients without secondary infections (27.8% and 5.4%, respectively; p = 0.001). Conclusions: The development of secondary infections in patients with hematological malignancy was not very rare. Greater concern should be shown for these infections to increase patient survival rates.

Counterpoint: Routine Anti-Bacterial Prophylaxis Is Not Indicated in Neutropenic Patients With Hematological Malignancies

2004 ◽  
Vol 2 (5) ◽  
pp. 445-451 ◽  
Author(s):  
Michael Kleinberg
Keyword(s):  
Bacterial Infections ◽  
Hematological Malignancies ◽  
Survival Rates ◽  
Hematologic Malignancies ◽  
Antibacterial Prophylaxis ◽  
Fluoroquinolone Antibiotics ◽  
Repeated Observation ◽  
Routine Prophylaxis ◽  
Immunosuppressed Patients ◽  
Neutropenic Patients

Preventing bacterial infections by prescribing prophylactic antibiotics is seen by many as an important strategy for decreasing infectious mortality in the most profoundly immunosuppressed patients with hematologic malignancies. Comparative studies show consistently that neutropenic patients treated with prophylactic fluoroquinolone antibiotics develop fewer bacteremias than patients treated with placebo or less-potent antibacterials. However, these same studies fail to show increased survival rates in fluoroquinolone-treated patients. This repeated observation is the basis for the continued controversy concerning universal antibacterial prophylaxis of neutropenic patients, namely, the inability to translate the observed reduction in culture-proven bacterial infections with prophylaxis into improved clinical outcomes. The answer to this controversy lies in the effectiveness of empiric antibacterial therapy in response to neutropenic fevers. Mortality from bacterial infections is 1% or less for patients enrolled in empiric treatment trials who do not receive prophylactic antibacterials. Therefore, routine fluoroquinolone prophylaxis offers essentially no potential survival benefit to neutropenic patients with hematologic malignancies. In fact, the increasing potential for fluoroquinolones to select for resistant bacterial pathogens should give pause to the practice of routine prophylaxis of neutropenic patients.

scholarly journals Long-term clinical outcome following lower limb arterial angioplasty

2011 ◽  
Vol 93 (3) ◽  
pp. 250-254 ◽  
Author(s):  
G Morris-Stiff ◽  
M Moawad ◽  
N Appleton ◽  
G Davies ◽  
E Hicks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Lower Limb ◽  
Patient Survival ◽  
Survival Rates ◽  
Disease Process ◽  
District General Hospital ◽  
Underlying Disease ◽  
Technical Success Rate ◽  
Actual Patient

INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1,2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.

scholarly journals 2268. Clinical Implications of Azole-Resistant vs. Azole-Susceptible Invasive Aspergillosis in Hematological Malignancy (CLARITY): A Multicenter Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S776-S776
Author(s):  
Danila Seidel ◽  
Oliver Cornely ◽  
Dorothee Arenz ◽  
Jacques Meis ◽  
Jörg Vehreschild ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Underlying Disease ◽  
Clinical Implications ◽  
Central Laboratory ◽  
Resistant Group ◽  
Study Completion ◽  
Worldwide Network ◽  
Susceptible Group

Abstract Background In recent years, survival of patients with invasive aspergillosis (IA) has improved mainly due to availability of extended spectrum triazoles. These advances are jeopardized by the emergence of azole resistance in Aspergillus fumigatus, the most common causative pathogen of IA. Despite several studies suggesting high probability of azole treatment failure in patients with azole-resistant isolates, the clinical implications of azole-resistant IA compared with azole-susceptible IA remain unclear. Methods In patients with hematological malignancies, cases of proven or probable IA (EORTC/MSG 2008) caused by A. fumigatus are registered. Retrospective data are documented, comprising demographics, diagnosis, treatment, response and outcome. Participating sites provided susceptibility results or isolates. Provided isolates were analyzed in a central laboratory. Results Since January 2018, 51 sites in 15 countries worldwide enrolled 154 cases diagnosed with IA between 2010 and 2019, of which 23 (14.9%) had azole-resistant IA. Of 44 cases, the respective clinical fungal isolate was analyzed in the central laboratory. A mixed fungal infection was reported for 34 patients (22.1%), 1 (2.9%) in the azole-resistant group; most were related to non-fumigatus Aspergillus species (n = 12, 35.3%) and non-Aspergillus molds (n = 10, 29.4). Most patients were male (n = 98, 63.6%); 19 (82.6%) in the azole-resistant group, 79 (60.3%) in the azole-susceptible group. Age was documented in categories instead of the exact age. Median age group was 50–69 years in both groups (ranging from 7–11 to 70–89 years for azole-resistant cases, 1–12 months to 70–89 years for azole-susceptible cases). Underlying disease and survival are shown in the table. Conclusion A worldwide network of investigators contributes to the CLARITY registry study. Completion of recruitment and subsequent data analysis are planned for 2019. Further sites may be added if azole-resistant cases are encountered. Disclosures All authors: No reported disclosures.

scholarly journals Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode

2015 ◽  
Vol 32 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Aslıhan Demirel ◽  
Fehmi Tabak ◽  
M. Cem Ar ◽  
Bilgül Mete ◽  
Şeniz Öngören ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Hematological Malignancies ◽  
Secondary Infections ◽  
Neutropenic Episode

scholarly journals 985. Fusarium Infections in Patients with Hematological Malignancies

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S583-S584
Author(s):  
Gayathri Krishnan ◽  
Anupam Pande
Keyword(s):  
Risk Factors ◽  
Statistical Analysis ◽  
Median Duration ◽  
Hematological Malignancies ◽  
Hematological Malignancy ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Cell Transplant ◽  
Surgical Specimen ◽  
Exact Test

Abstract Background Fusarium is a ubiquitous mold that can cause invasive and disseminated fusariosis in immunosuppressed patients, especially those with hematological malignancies. The risk factors associated with mortality of patients with Fusarium infections have not been adequately assessed in literature. In this study, we sought to explore the characteristics, clinical outcomes, and risk factors for mortality in Fusarium infections in patients with hematological malignancies. Methods This is a retrospective study of adult hematological malignancy patients admitted to surgical/medical wards or critical units at an academic medical center from January 2010 to January 2021 and diagnosed with proven invasive Fusarium infections through positive microbiological culture data from a biopsy, surgical specimen or sterile site. Primary end point was 30-day mortality. Statistical analysis was done using Fischer’s exact test and Mann-Whitney U test. Results 31 patients with hematological malignancies were identified with proven Fusarium infections during the 10-year period (13,390 total unique patients with diagnosis of hematologic malignancies). Two were excluded due to incomplete data. Demographic characteristics, type and status of hematological malignancy, chemotherapy, exposure to steroids, neutropenia, lymphopenia, antifungal prophylaxis, and other factors were analyzed. Mean age at diagnosis was 52.6 years. 16/29 (55.2%) had undergone stem cell transplant prior to infection with median duration of 150.5 days (range 12 to 1503) prior to infection. The most common pathologies were invasive sinusitis and disseminated cutaneous infection in 13/29 (44.8%) patients. Blood culture was positive in 5/29 (17.2%). Overall mortality was 86.2% with 30-day mortality of 44.8% and 1-year mortality of 83%. Death was attributed to fusariosis in 12/25 (48%). Median duration to death was 56 days (range 2 to 1627 days). Risk factors for 30-day mortality were assessed (table 1). The table describes risk factors for 30-day mortaity for fusarium infections in patients with hematological malignancies. statistical analysis done using fischer’s exact test Conclusion Fusarium infections result in morbidity and mortality in patients with hematological malignancies. A variety of host and disease factors dictate eventual outcome of Fusarium infections in these patients. Lack of neutrophil recovery is a significant risk factor for 30-day mortality in this population. Disclosures All Authors: No reported disclosures

scholarly journals Secondary hematological malignancies following breast cancer treatment

2011 ◽  
Vol 4 (1) ◽  
pp. 51
Author(s):  
Soley Bayraktar ◽  
Maricer P. Escalon
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Treatment ◽  
Survival Time ◽  
Hematological Malignancies ◽  
Survival Rates ◽  
Clinical Problem ◽  
Breast Cancer Treatment ◽  
Western Countries

Breast cancer (BC) incidence has increased among women in most Western countries. Concurrently, the survival time of BC patients has increased with 5-year survival rates reaching 80–90%. Secondary hematological malignancies (SHM) following BC treatment are an issue of concern to clinicians and also to patients and their families. However, therapy-induced leukemia after BC is an underemphasized clinical problem. In this review,we will focus on the incidences and patterns of occurrence ofSHM in patients with BC. We will address risk factors for the development of SHM and we will explore how secondary hematological malignancies impact the survival of BC patients.

scholarly journals Comorbidities in ANCA-associated vasculitis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_3) ◽  
pp. iii79-iii83 ◽  
Author(s):  
Andreas Kronbichler ◽  
Johannes Leierer ◽  
Philipp Gauckler ◽  
Jae Il Shin
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Survival Rates ◽  
Coagulation Factors ◽  
Underlying Disease ◽  
Current Control ◽  
Anca Associated Vasculitis ◽  
Cardiovascular Risk Prediction ◽  
Increased Risk ◽  
The Impact

Abstract The prognosis of patients with ANCA-associated vasculitis has improved over the past decades, but overall survival rates are still unsatisfactory. Recent research has focused on complications of immunosuppressive measures and comorbidities of ANCA-associated vasculitis. This review focuses on thromboembolic and cardiovascular events. A considerably increased risk of thromboembolic events has been reported, which is associated with active disease and impaired coagulation factors. There is mounting evidence that a hypercoagulable state is present even in patients in remission, and studies investigating the impact of tailored anticoagulation are needed to reduce the burden of thromboembolism. Cardiovascular mortality is one of the leading causes of death and accelerated atherosclerosis is frequently observed in patients with ANCA-associated vasculitis. A high frequency of patients develops hypertension, diabetes mellitus and hypercholesterolaemia, either as a consequence of immunosuppression or associated with the underlying disease. The current control of modifiable cardiovascular risk factors is insufficient and thorough reviews should be performed periodically. Treatment of these risk factors should be adopted according to current recommendations related to individual cardiovascular risk prediction.

scholarly journals The survival rates and risk factors of implants in the early stage: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong Yang ◽  
Huiting Hu ◽  
Mianyan Zeng ◽  
Hongxing Chu ◽  
Zekun Gan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
Dental Implants ◽  
Bone Quality ◽  
Early Stage ◽  
Survival Rates ◽  
Bone Augmentation ◽  
Early Survival ◽  
Immediate Implantation ◽  
Implant Length

Abstract Background Few large-sample studies in China have focused on the early survival of dental implants. The present study aimed to report the early survival rates of implants and determine the related influencing factors. Methods All patients receiving dental implants at our institution between 2006 and 2017 were included. The endpoint of the study was early survival rates of implants, according to gender, age, maxilla/mandible, dental position, bone augmentation, bone augmentation category, immediate implant, submerged implant category, implant diameter, implant length, implant torque, and other related factors. Initially, SPSS22.0 was used for statistical analysis. The Chi-square test was used to screen all factors, and those with p < 0.05 were further introduced into a multiple logistic regression model to illustrate the risk factors for early survival rates of implants. Results In this study, we included 1078 cases (601 males and 477 females) with 2053 implants. After implantation, 1974 implants were retained, and the early survival rate was 96.15%. Patients aged 30–60 years (OR  2.392), with Class I bone quality (OR  3.689), bone augmentation (OR  1.742), immediate implantation (OR  3.509), and implant length < 10 mm (OR  2.972), were said to possess risk factors conducive to early survival rates. Conclusions The early survival rate of implants in our cohort exceeded 96%, with risk factors including age, tooth position, bone quality, implant length, bone augmentation surgery, and immediate implantation. When the above factors coexist, implant placement should be treated carefully.

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