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 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.

scholarly journals ESCHERICHIA COLI: AN IMPORTANT PATHOGEN IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES

2014 ◽  
Vol 6 (1) ◽  
pp. e2014068 ◽  
Author(s):  
Daniel Olson ◽  
Abraham Tareq Yacoub ◽  
Gelenis Domingo ◽  
John Norman Greene
Keyword(s):  
Hematologic Malignancy ◽  
Retrospective Chart Review ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Prophylactic Therapy ◽  
E Coli ◽  
Immunosuppressed Patients ◽  
Hospital Stays ◽  
Neutropenic Patients ◽  
Clinically Significant

AbstractBackgroundEscherichia coli (E. coli) is a pathogen of great concern in immunosuppressed patients.  While antimicrobial prophylactic therapy has become the standard, the emergence of resistant pathogens has some questioning its use.  This study describes our experience with E.coli as a pathogen in neutropenic patients with a hematologic malignancy, and addresses future directions of treatment for this patient population.MethodsA retrospective chart review of 245 E.coli bacteremia patients at Moffitt Cancer Center from 05/18/02 – 05/15/12 was conducted. Patients were identified via microbiology laboratory computerized records.ResultsThe included patients experienced clinically significant E.coli bacteremia resulting in a median hospital stay of 14.7 days.  Several patients developed severe sepsis requiring the use of pressor and ventilator therapy.ConclusionsE.coli is a major pathogen in these patient populations resulting in extended hospital stays and specialized treatment to overcome their E.coli bacteremia. The data supports the use of fluoroquinolone prophylactic therapy, however, earlier detection and treatment of neutropenic infection is needed.

scholarly journals 2685. Oral Third-Generation Cephalosporins vs. Levofloxacin for Antibacterial Prophylaxis in Neutropenic Patients with Hematologic Malignancies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S943-S943
Author(s):  
Catherine DeVoe ◽  
Trang D Trinh ◽  
Joshua Moises ◽  
Binh C Pham ◽  
Allen V Tran ◽  
...  
Keyword(s):  
San Francisco ◽  
Lymphoblastic Leukemia ◽  
B Cell Lymphoma ◽  
Hematologic Malignancies ◽  
Multivariable Logistic Regression Analysis ◽  
Antibacterial Prophylaxis ◽  
Cell Transplant ◽  
Third Generation ◽  
Neutropenic Patients ◽  
Third Generation Cephalosporins

Abstract Background Fluoroquinolone (FQ) prophylaxis for high-risk neutropenic patients has been shown to reduce rates of febrile neutropenia and is standard at many centers. For patients who cannot receive a FQ, oral third-generation cephalosporins (OTGCs) are often used as an alternative; however, this strategy is not well studied. We sought to compare clinically-relevant outcomes in patients receiving FQ vs. OTGC prophylaxis. Methods This was a retrospective cohort study of adults who were admitted to the Malignant Hematology service at the University of California, San Francisco between December 2012 and June 2018 and received >48 hours of an OTGC (cefdinir or cefpodoxime) or an FQ (levofloxacin) for neutropenic prophylaxis. For each OTGC patient, an FQ patient was randomly selected from the same admission year. Exclusion criteria were fever on admission, receipt of systemic antibiotics prior to or during the prophylaxis period, diagnosis of acute promyelocytic leukemia, and crossover. A multivariable logistic regression analysis adjusting for age, QTc, Charlson Comorbidity Index, underlying diagnosis, receipt of stem cell transplant (SCT), and duration of neutropenia was used to compare the groups with respect to a primary composite outcome of 30-day in-hospital mortality, intensive care unit (ICU) admission, and bacteremia. Results Of 520 patients screened, 173 (33.3%) were included in the study; 76 of these received an OTGC and 97 received an FQ. Hematologic diagnoses included multiple myeloma (38.2%), acute myeloid leukemia (29.5%), acute lymphoblastic leukemia (8.7%), B-cell lymphoma (12.7%), aplastic anemia (2.9%), and others (3.5%). During admission, 9.2% underwent allogeneic SCT and 28.3% underwent autologous SCT. Outcomes are shown in Table 1. Conclusion Prophylaxis with an OTGC rather than a FQ was not associated with worse outcomes in this pragmatic evaluation of a heterogeneous group of patients with hematologic malignancies. In this multivariable model, neutropenia lasting more than 7 days was the only consistent predictor of failure across outcomes, suggesting that degree of immunosuppression is a much more significant driver of poor outcomes in this population than is prophylaxis choice. Further evaluation of the role of prophylaxis is needed. Disclosures All authors: No reported disclosures.

scholarly journals Causes of transfer and mortality in children with oncohematological diseases admitted to the intensive care unit

2021 ◽  
Vol 20 (1) ◽  
pp. 180-183
Author(s):  
F. S. Aliyeva ◽  
M. S. Muldahmetov ◽  
B. K. Nurmagambetova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hematological Malignancies ◽  
Survival Rates ◽  
Pediatric Intensive Care ◽  
Hematologic Malignancies ◽  
Point Of View ◽  
Biological Knowledge ◽  
General Tendency ◽  
Ethical Point

The last few decades survival rates of children with hematologic malignancies have improved significantly, due to a potentially curative chemotherapy protocols, the expansion of biological knowledge and innovative methods of therapy. However oncohematological pediatric patients are at high risk for rapid clinical deterioration due to numerous factors such as the severity of the underlying condition, interventions toxicity and associated immunosuppression. Using aggressive tactics of therapy with oncohematological diseases in children is also associated with complications and life-threatening events that lead to admission to the pediatric intensive care unit. Historically, these children have been considered as poor candidates for intensive care. Discussions around the transfer of children with hematological malignancies to intensive care units and also the expected prognosis raised complicate and delicate questions, especially from an ethical point of view. Despite the general tendency of improved survival rate, mortality in the intensive care unit on hematological malignancies children, unfortunately, is still high and, in comparison to adults, has remained relatively invariable over the past decades. These findings highlight the necessity for research in this group of patients. 

scholarly journals The Management of Hematologic Patients with Bloodstream Infections Due to Multi-Drug Resistant Bacteria: Where Do We Stand? From Antibacterial Prophylaxis to the Treatment of Septic Shock

Hemato ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 60-76
Author(s):  
Carolina Secreto ◽  
Alessandro Busca ◽  
Tommaso Lupia ◽  
Silvia Corcione ◽  
Francesco Giuseppe De Rosa
Keyword(s):  
Septic Shock ◽  
Bacterial Infections ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Limiting Factors ◽  
Resistant Bacteria ◽  
Antibacterial Prophylaxis ◽  
Drug Resistant ◽  
Drug Resistant Bacteria ◽  
Threatening Condition

Bloodstream infection (BSI) and septic shock represent one of the major limiting factors for the successful treatment of patients affected by hematologic malignancies. During the most recent years we have documented a shift in the epidemiology of bacterial infections toward a consistent rise of Gram-negative rods. In addition, the emergence of multi-drug-resistant bacteria is considered a life-threatening condition requiring a multi-disciplinary approach. Aim of present review is to summarize the most recent approaches in terms of anti-microbial prophylaxis and treatment of BSI in hematologic patients with neutropenic fever.

scholarly journals Antibiotic Rotation for Febrile Neutropenic Patients with Hematological Malignancies: Clinical Significance of Antibiotic Heterogeneity

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e54190 ◽  
Author(s):  
Yong Chong ◽  
Shinji Shimoda ◽  
Hiroko Yakushiji ◽  
Yoshikiyo Ito ◽  
Toshihiro Miyamoto ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Hematological Malignancies ◽  
Neutropenic Patients

The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients

2016 ◽  
Vol 37 (7) ◽  
pp. 845-851 ◽  
Author(s):  
Marie-Paule Fernandez-Gerlinger ◽  
Anne-Sophie Jannot ◽  
Sophie Rigaudeau ◽  
Juliette Lambert ◽  
Odile Eloy ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Severe Infection ◽  
Hematologic Malignancies ◽  
Preventive Strategies ◽  
European Organization ◽  
Exact Test ◽  
Eortc Criteria ◽  
Neutropenic Patients ◽  
Chemotherapy Induced Neutropenia ◽  
The Impact

OBJECTIVEInvasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study.DESIGNRetrospective cohort studyMETHODSPatients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher’s exact test, and a multivariate analysis was performed to take into account potential confounding factors.RESULTSData from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00–0.84).CONCLUSIONIn this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies.Infect Control Hosp Epidemiol 2016;37:845–851

scholarly journals Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies

Leukemia ◽  
2005 ◽  
Vol 19 (4) ◽  
pp. 545-550 ◽  
Author(s):  
K Mühlemann ◽  
C Wenger ◽  
R Zenhäusern ◽  
M G Täuber
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Hematologic Malignancies ◽  
Neutropenic Patients
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