Impact of duration of antibiotic therapy on the prognosis of patients with acute myeloid leukemia who had Gram-negative bloodstream infection in consolidation chemotherapy / 中华血液学杂志

Objectives: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. Methods: Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. Results: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×10(9)/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. Conclusion: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.

Impact of duration of antibiotic therapy on the prognosis of patients with acute myeloid leukemia who had Gram-negative bloodstream infection in consolidation chemotherapy / 中华血液学杂志

Objectives@#To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. @*Methods@#Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. @*Results@#A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×109/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. @*Conclusion@#Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.

Reactive Arthritis in a Patient with Chlamydia trachomatis Infection / 대한정형외과학회잡지

The authors report a case of reactive arthritis that was caused by sexual contact as below example. A 36-year-old male visited our center due to sudden pain in wrist joint, the 3rd finger, knee joint, and achilles tendon. There were no specific abnormalities for the immunoserologic tests and magnetic resonance imaging; however, we found a positive test result for the polymerase chain reaction test of urine that identified Chlamydia trachomatis. Through considering the patient's medical history and various examinations, we considered the possibility of reactive arthritis, to the exclusion of alternate diagnosis. According to the our diagnosis, the patient was treated with antibiotics and nonsteroidal anti-inflammatory drugs and we found that the patient was getting better. Therefore the authors think that we have to contemplate the possibility of reactive arthritis and treat appropriately in patients with similar symptoms.

A Study on Clinical Characteristics of Maxillary Sinusitis in Korean Children

PURPOSE: Paranasal sinusitis, easily overlooked owing to it's benign symptomatology, should be considered when the upper respiratory tract infction persists longer than seven days. Without early recognition and appropriate management, the disease will take a chronic course and the incidence of complications will be increased. The significance of paranasal sinusitis among Korean children has not appropriately been appreciated; therefore, a clinical study was under-taken to help understand clinical characteristics of paranasal sinusitis in Korean children. METHODS: One hundred sixty five(34.3%), out of 481 patients with no underlying disease seen at the outpatient division of the department of pediatrics, Hanyang university hospital from April 1992 to August 1993, were diagnosed of maxillary sinusitis and included in the study to investigate age and sex distributions, clinical manifestations, radiographic findings, and response to antibiotics therapy. Five patients followed up for less thant two weeks and 45 patients lost in follow up within 3 weeks were excluded in the evaluation of therapeutic response, which were done on the basis of clinical and radiographical analysis. RESULTS: 1) Maxillary sinusitis occurred frequently in young children; among 165 patients, 129 patients(78.3%) were wunder 5 years of age, with 83 patients(50.4%) younger than 3 years of age. The male to female ratio was 1.4:1. 2) One hundred twently three patients(74.5%) had acute sinusitis, 39 patients(23.7%) subacute sinusitis, and 3 patients(1.8%) chronic sinusitis. The most common clinical symptom was cough in 124 patients(75.2%), followed by nasal discharge in 103 patients(62.4%), nasal obstruction in 76 patients(46.1%), and fever in 49 patients(29.7%). The physical finding most commonly observed was postnasal drip in 35 patients(21.2%), followed by otitis media in 21 patients(12.7%), and throat injection in 19 patients(11.5%); however, physical examination was not contributory in 77 patients(46.7%). 3) Radiographic findings on Water's view illustrated opacification in 98 patients(59.4%), mucoperiosteal thickening in 82 patients(49.7%), and air-fluid level in 4 patients(2.4%). Bi-lateral radiographic involvement was 4 times more common than unilateral one. 4) The patients with maxillary sinusitis were trated with amoxicillin(AMX), trimethoprim-sulfamethoxazole(TMP-SMZ)+/-erythromycin(EM), amoxicillin-clavulanate(AMX-CLV) or cefaclor(CCL) in sequence depending on the therapeutic response to each antibiotics. The therapeutic outcome with each antibiotics was 16.3%(15/92) with AMX, 56.7%(51/90) with TMP-SMZ, 70.6%(24/34) with AMX-CLV or CCL. Among 115 patients who have been followed up longer than 3 weeks , 90 patients(78.3%) improved clinically and/or radiographically. Among 90 patients with improvement, 32 patients(35.5%) showed clinical and/or radiographical responses in less than 3 weeks of treatment with effective antibiotics, however 19 patients(21.2%) needed to be treated for longer than 7 weeks. CONCLUSIONS: The data indicated that paranasal sinusitis is a common disease among Korean children, especially in very young ones. Once antibiotic therapy had begun, the follow-up were not infrequently interrupted. The therapeutic response to antibiotics, recommended currently for therapy of paranasal sinusitis, were not good.