RESUMEN
Limited data are available on antimicrobials exposure and microbiology evolution in pediatric acute myeloid leukemia (AML) patients underwent antimicrobials prophylaxis. To assess the effectiveness of antimicrobials prophylaxis, antibiotic susceptibilities of bacteria, and exposure of antimicrobials during intensive chemotherapy for AML patients, 90 consecutive de novo AML patients aged 0-18 years between January 1, 1997 and March 31, 2018 were enrolled. Vancomycin, ciprofloxacin and voriconazole prophylaxis was administered from January 1, 2010. During the preprophylaxis period, January 1997 to December 2009, 62 patients experienced a total of 87 episodes of bloodstream infection (BSI) and 17 episodes of invasive fungal infection (IFI) among 502 courses of chemotherapy. In contrast, 16 episodes of BSI occurred and no IFIs were reported to occur in 28 patients who received 247 courses of chemotherapy in the prophylaxis period. Patients who received antimicrobial prophylaxis had a significant reduction of BSI, IFI, and febrile neutropenia in comparison with patients without prophylaxis. Exposure to amikacin, carbapenem, amphotericin B was reduced in the prophylaxis period. Imipenem susceptibility of Enterobacter cloacae as well as vancomycin susceptibility of Enterococcus species were reduced in the prophylaxis period. At the time of the last follow up, patients with prophylaxis had a better subsequent 5-year overall survival rate than those without prophylaxis. Prophylactic antimicrobials administration in children with AML who undergo chemotherapy can significantly reduce the rates of life-threatening infection, exposure to antimicrobials, and might result in a better outcome.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Antifúngicos/uso terapéutico , Bacteriemia/prevención & control , Neutropenia Febril/prevención & control , Leucemia Mieloide Aguda/microbiología , Micosis/prevención & control , Antibacterianos/administración & dosificación , Antifúngicos/administración & dosificación , Bacteriemia/tratamiento farmacológico , Niño , Ciprofloxacina/administración & dosificación , Ciprofloxacina/uso terapéutico , Neutropenia Febril/tratamiento farmacológico , Femenino , Humanos , Imipenem/administración & dosificación , Imipenem/uso terapéutico , Leucemia Mieloide Aguda/complicaciones , Masculino , Micosis/tratamiento farmacológico , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico , Voriconazol/administración & dosificación , Voriconazol/uso terapéuticoAsunto(s)
Aeromonas veronii , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/cirugía , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/cirugía , Aeromonas veronii/aislamiento & purificación , Anciano , Antibacterianos/administración & dosificación , Cefepima/administración & dosificación , Ciprofloxacina/administración & dosificación , Terapia Combinada , Tratamiento Conservador , Quimioterapia de Consolidación/efectos adversos , Desbridamiento , Quimioterapia Combinada , Fascitis Necrotizante/microbiología , Infecciones por Bacterias Gramnegativas/complicaciones , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/microbiología , Masculino , Resultado del TratamientoRESUMEN
Patients with hematologic malignancies as well as allogeneic hematopoietic stem cell transplantation (HSCT) patients are at high risk for invasive aspergillosis. Here, we report a culture- and autopsy-proven fatal invasive aspergillosis in an allogeneic HSTC patient which he developed despite posaconazole prophylaxis. The agent was determined to be an azole-resistant Aspergillus fumigatus strain bearing the cyp51A mutation combination TR46 Y121F M172I T289A. At increasing frequency, the azole resistance of A. fumigatus is being reported globally, limiting treatment options and complicating regimens.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/genética , Azoles/uso terapéutico , Sistema Enzimático del Citocromo P-450/genética , Farmacorresistencia Fúngica Múltiple/genética , Proteínas Fúngicas/genética , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Anciano , Alelos , Anfotericina B/uso terapéutico , Caspofungina , Equinocandinas/uso terapéutico , Humanos , Aspergilosis Pulmonar Invasiva/microbiología , Leucemia Mieloide Aguda/microbiología , Lipopéptidos/uso terapéutico , Masculino , Pruebas de Sensibilidad Microbiana , Mutación/genética , Resultado del Tratamiento , Triazoles/uso terapéutico , Voriconazol/uso terapéuticoRESUMEN
PURPOSE: Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. There is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting. METHODS: A retrospective chart review was completed comparing the use of prophylactic moxifloxacin to that of levofloxacin or ciprofloxacin during periods of prolonged neutropenia. Adult patients admitted to a community teaching hospital while receiving induction or reinduction chemotherapy for acute myeloid leukemia were included. RESULTS: One hundred and forty-one patients were included in this study. The two groups displayed slight heterogeneity: patients receiving moxifloxacin were approximately 10 years younger (54 vs. 64 years, p = 0.01), more likely to receive granulocyte colony stimulating factor (GCSF) (45 vs. 19%, p = 0.001), and neutropenic for a longer duration (23 vs. 19 days, p = 0.009). The incidence of febrile neutropenia (76 vs. 81%, RR 0.93, 95% CI 0.78-1.11, p = 0.42) and of documented infections (27 vs. 33%, RR 0.82, 95% CI 0.49-1.36, p = 0.44) was similar between those receiving moxifloxacin and levofloxacin/ciprofloxacin, respectively. Hospital readmission for an infectious issue within 30 days of hospital discharge (9 vs. 5%, p = 0.39) was also similar between groups as was the incidence of Clostridium difficile (9 vs. 9%, p = 0.96). CONCLUSIONS: Moxifloxacin may be an alternative to levofloxacin or ciprofloxacin in patients with a prolonged risk of febrile neutropenia requiring prophylaxis.
Asunto(s)
Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Fluoroquinolonas/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Levofloxacino/uso terapéutico , Adulto , Anciano , Profilaxis Antibiótica/métodos , Clostridioides difficile/aislamiento & purificación , Enterocolitis Seudomembranosa/prevención & control , Femenino , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Leucemia Mieloide Aguda/microbiología , Masculino , Persona de Mediana Edad , Moxifloxacino , Neutropenia/inducido químicamente , Neutropenia/microbiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios RetrospectivosRESUMEN
Background. Saprochaete capitata (formerly known as Geotrichum capitatum and Blastoschizomyces capitatus) is a ubiquitous fungus found in soil, water, air, plants and dairy products. It colonizes the skin, and bronchial and intestinal tract of healthy people producing serious opportunistic infections in patients with haematological malignancies, especially in those with acute leukaemia. Since 1960s its presence is being increasingly recognized in this group of patients. The clinical spectrum of S. capitata disseminated infections is very similar to that produced by Candida, being easily misinterpreted. The associated high mortality and low susceptibility to fluconazole and echinocandins of S. capitata require the acknowledgement of this emergent infection so that it can be properly treated. Case report. We report 5 new cases of S. capitata disseminated infection in patients with advanced haematological malignancies observed in the haematology unit between the years 2004 and 2010, and review the state-of-the-art for diagnosis and treatment of this infection. Conclusions. Based on our experience, the prophylactic use of or the empirical antifungal treatment with fluconazole and/or echinocandins would not be adequate for oncohaematological patients in those hospitals where S. capitata infection may be highly prevalent (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Geotrichum , Geotrichum/aislamiento & purificación , Patología Molecular/instrumentación , Patología Molecular/métodos , Patología Molecular/normas , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/microbiología , Anticuerpos Antifúngicos , Antifúngicos , Pruebas de Sensibilidad Microbiana/métodos , Pruebas de Sensibilidad Microbiana , Sensibilidad y Especificidad , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/microbiología , Azoles/uso terapéuticoRESUMEN
A case of disseminated infection with Fusarium oxysporum following chemotherapy of acute myelogenous leukemia is reported. Antifungal treatment was successful with a 13-day course of oral terbinafine 250 mg t.i.d. in combination with amphotericin B deoxycholate 1.0-1.5 mg/kg qd and subsequently intravenous liposomal amphotericin B 5 mg/kg qd. Preceding monotherapy with amphotericin B deoxycholate 1.0-1.5 mg/kg qd had not stopped the progression of infection. The combination therapy described here represents a novel approach to the treatment of Fusarium spp. in the immunocompromised host in whom Fusarium spp. are known to cause disseminated infection with high mortality.
Asunto(s)
Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Dermatomicosis/tratamiento farmacológico , Fusarium , Naftalenos/administración & dosificación , Dermatomicosis/sangre , Dermatomicosis/inmunología , Dermatomicosis/patología , Quimioterapia Combinada , Humanos , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/microbiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Naftalenos/sangre , Neutropenia/tratamiento farmacológico , Neutropenia/patología , Terbinafina , Resultado del TratamientoRESUMEN
230 leukaemic patients were entered into a randomised, prospective, multicentre trial of either ciprofloxacin (1 g/day) or co-trimoxazole (1920 mg/day) plus colistin (800 mg/day) for the prevention of infection during granulocytopenia. Bacteraemia due to resistant gram-negative rods occurred only in the co-trimoxazole-colistin group though both regimens were effective for selective gastrointestinal tract decontamination. However, there were fewer patients without any infective complications (31% vs. 18%: P = 0.02), fewer febrile days [mean (S.D.) 5.9 (1.1) vs. 8.2 (1.4): P = 0.0242], a lower proportion of infective events (0.9 (0.16) vs. 1.2 (0.18): P = 0.005) and fever occurred later (median 19 vs. 14 days: 0.025 less than P less than 0.05) in the co-trimoxazole-colistin group. The choice of prophylactic regimen therefore appears to depend upon whether or not protection against gram-negative infection is required or better systemic prophylaxis overall.