Management of the Febrile Neutropenic Patient: A Consensus Conference

Picazo, Juan J.

doi:10.1086/383041

Cited by 30 publications

(12 citation statements)

References 78 publications

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“…The development of antimicrobial resistance by Gramnegative bacilli is a worldwide phenomenon that has been observed among immunocompetent and immunocompromised hosts, including patients with hematologic malignancies and hematopoietic stem cell transplantation (HSCT) recipients (1). A relationship between resistance and poor outcome has been documented in several settings, and has been attributed mostly to the use of inappropriate antibiotic regimens, or to a delay in starting appropriate treatment (2).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients

Garnica

Maiolino

Nucci

2009

Braz J Med Biol Res

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The epidemiology of bacteremia developing during neutropenia has changed in the past decade, with the re-emergence of Gramnegative (GN) bacteria and the development of multidrug resistance (MDR) among GN bacteria. We conducted a case-control study in order to identify factors associated with bacteremia due to multidrug-resistant Gram-negative (MDRGN) isolates in hematopoietic stem cell transplant recipients. Ten patients with MDRGN bacteremia were compared with 44 patients with GN bacteremia without MDR. Bacteremia due to Burkholderia or Stenotrophomonas sp was excluded from analysis (3 cases), because the possibility of intrinsical resistance. Infection due to MDRGN bacteria occurred in 2.9% of 342 hematopoietic stem cell transplant recipients. Klebsiella pneumoniae was the most frequent MDRGN (4 isolates), followed by Pseudomonas aeruginosa (3 isolates). Among non-MDRGN, P. aeruginosa was the most frequent agent (34%), followed by Escherichia coli (30%). The development of GN bacteremia during the empirical treatment of febrile neutropenia (breakthrough bacteremia) was associated with MDR (P < 0.001, odds ratio = 32, 95% confidence interval = 5-190) by multivariate analysis. Bacteremia due to MDRGN bacteria was associated with a higher death rate by univariate analysis (40 vs 9%; P = 0.03). We were unable to identify risk factors on admission or at the time of the first fever, but the occurrence of breakthrough bacteremia was strongly associated with MDRGN bacteria. An immediate change in the antibiotic regimen in such circumstances may improve the prognosis of these patients.

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Section: Introductionmentioning

confidence: 99%

Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients

Garnica

Maiolino

Nucci

2009

Braz J Med Biol Res

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“…4 Hal ini menuntut pembaruan data dasar mengenai kuman penyebab demam neutropenia secara berkala. 5 Pengklasifikasian pasien demam neutropenia menjadi risiko rendah dan tinggi merupakan strategi yang baik untuk meningkatkan efektivitas terapi dan membantu menentukan jenis antibiotik serta memperkirakan luaran pasien. 6 Rondinelli dkk 7 mengusulkan suatu sistem skoring untuk mengelompokkan pasien demam neutropenia ke dalam risiko rendah, sedang, atau risiko tinggi.…”

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Etiologi Demam Neutropenia pada Anak dengan Keganasan dan Penggunaan Skor Klasifikasi Rondinelli

Adrieanta

Windiastuti

Handryastuti

2016

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“…7,8 Recently published guidelines have addressed the role of newer quinolones as promising agents in the care of low-risk cancer patients with febrile neutropenia, although to our knowledge studies with these agents currently are lacking. 2,16 Moxifloxacin, a new broad-spectrum quinolone, is reported to have increased potency against gram-positive pathogens and anaerobes compared with older quinolones, while it reportedly retains significant activity against the majority of gram-negative pathogens responsible for infections in cancer patients. [17][18][19] In addition, moxifloxacin is administered once daily and has a favorable pharmacokinetic and pharmacodynamic profile, a lower incidence of adverse effects, fewer drug interactions, and lower mutation potency.…”

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confidence: 99%

Outpatient treatment of low‐risk neutropenic fever in cancer patients using oral moxifloxacin

Chamilos¹,

Bamias²,

Efstathiou³

et al. 2005

Cancer

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BACKGROUNDOral‐based antibiotic therapy is the standard of care in the management of cancer patients with low‐risk neutropenic fever. Nevertheless, to the authors' knowledge, the best antibiotic regimen and the feasibility of ambulatory treatment have not been clearly defined.METHODSThe authors evaluated the efficacy and safety of moxifloxacin as outpatient treatment in cancer patients with febrile neutropenia who were selected according to the recently proposed Multinational Association for Supportive Care in Cancer (MASCC) risk assessment model. Moxifloxacin was given at a dose of 400 mg orally once daily.RESULTSFifty‐four patients with solid and hematologic malignancies, the majority of whom (84%) had advanced disease, were included in the current study. The median neutrophil count at the time of study entry was 340/mm3 (range, 20–950/mm3) and the median duration of neutropenia was 4 days (range, 3–14 days). Of 55 neutropenic episodes, 50 (91%) had a successful outcome with a median time to defervescence of 2 days (range, 1–5 days). A multivariate analysis indicated that severe neutropenia (an absolute neutrophil count of < 100 mm3) was the only independent factor associated with treatment failure (P < 0.04). Moxifloxacin was found to be well tolerated and there were no infectious deaths reported.CONCLUSIONSThe results of the current study demonstrated that moxifloxacin was a highly effective and safe regimen in the outpatient treatment of cancer patients with febrile neutropenia. Cancer 2005. © 2005 American Cancer Society.

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Management of the Febrile Neutropenic Patient: A Consensus Conference

Cited by 30 publications

References 78 publications

Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients

Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients

Etiologi Demam Neutropenia pada Anak dengan Keganasan dan Penggunaan Skor Klasifikasi Rondinelli

Outpatient treatment of low‐risk neutropenic fever in cancer patients using oral moxifloxacin

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