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1.
Medicina (B.Aires) ; 81(3): 438-451, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346482

ABSTRACT

Resumen Las infecciones fúngicas invasoras (IFI) constituyen una de las principales complicaciones infecciosas en pacientes oncohematológicos y con trasplante de células progenitoras hematopoyéticas (TCPH), ocasionando alta morbimortalidad e incrementando significativamente los costos de atención y la estadía hos pitalaria. La epidemiología de las IFI ha cambiado en las últimas décadas, siendo los hongos filamentosos, particularmente Aspergillus spp., los principales agentes etiológicos. Existen múltiples factores de riesgo para una IFI; pero la neutropenia profunda y prolongada, y la inmunodeficiencia celular severa siguen siendo los más importantes. Por este motivo, la población de mayor riesgo la constituyen los pacientes con leucemias agudas, mielodisplasias y TCPH alogénicos con enfermedad injerto contra huésped (EICH), en tratamiento con corticoides. Numerosos ensayos clínicos aleatorizados y metaanálisis han demostrado que la profilaxis antifúngica primaria (PAF) reduce significativamente la incidencia de IFI, tanto de aquellas causadas por Candida spp. como por Aspergillus spp., la mortalidad relacionada a IFI y la mortalidad global en algunos grupos de pacientes. Asimismo, en enfermos de alto riesgo, en donde se espera una incidencia de IFI elevada, es una estrategia costo-efectiva. Varios antifúngicos han demostrado beneficio clínico y pueden utilizarse como estrategia de PAF en diferentes escenarios, presentando ventajas y desventajas que deben ser tenidas en cuenta al momento de indicar una PAF. Para esto, sociedades científicas nacionales e internacionales, han emitido recomendaciones de indicación de PAF. Se analizan los aspectos relacionados con la eficacia clínica de los diferentes antifúngicos según la población de riesgo, las potenciales desventajas, momento y forma de administración.


Abstract Invasive fungal infections (IFI) are among the main infectious complications in patients with hema tological malignancies and with hematopoietic stem cell transplant (HSCT), causing high morbidity and mortality and significantly increasing the healthcare cost and hospital stay. The epidemiology of IFIs has changed in recent decades, with filamentous fungi, particularly Aspergillus spp., being the main etiological agents. There are multiple risk factors for having an IFI; however, the most important are profound and prolonged neutropenia and severe cellular immunodeficiency. For this reason, the population at greatest risk is made up of patients with acute leukemias, myelodysplasias and allogeneic HSCT with graft-versus-host disease (GVHD) treated with cortico steroids. Numerous randomized clinical trials and meta-analyses have shown that primary antifungal prophylaxis (AFP) significantly reduces the incidence of IFI, particularly those caused by Candida spp. and Aspergillus spp., IFI-related mortality, and overall mortality in some group of patients. Likewise, in high-risk patients, where a high incidence of IFI is expected, it is a cost-effective strategy. Several antifungals have demonstrated clinical benefit. They can be used as a AFP strategy in different settings, presenting advantages and disadvantages that must be taken into account in each case. For this, national and international scientific societies have issued recom mendations for the indication of AFP. Aspects related to the different antifungals' clinical efficacy are analyzed considering the population at risk, the potential disadvantages, timing, and form of administration.


Subject(s)
Humans , Myelodysplastic Syndromes , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease , Neutropenia/drug therapy , Antifungal Agents/therapeutic use
2.
Rev. cuba. hematol. inmunol. hemoter ; 36(4): e1285, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289413

ABSTRACT

Introducción: La neutropenia febril incide frecuentemente en pacientes con hemopatías malignas y representa una urgencia médica; actualmente su manejo terapéutico constituye un verdadero reto debido a la aparición de infecciones por microorganismos multirresistentes y la coexistencia de factores dependientes del paciente y del tratamiento, lo cual contribuye a situaciones de riesgo para el desarrollo de complicaciones graves. Métodos: Se realizó una revisión exhaustiva del tema en las principales bases de datos de la Biblioteca Virtual de Salud, se utilizó como referencia artículos actualizados publicados principalmente en los últimos 5 años. Análisis y síntesis de la información: Se abordó fundamentalmente el enfoque diagnóstico y terapéutico en los pacientes de alto riesgo de complicaciones por infecciones bacterianas, así como su evaluación integral. Se incluyen herramientas recientes de pesquisa de sepsis y daño orgánico relacionado con ella, que constituyen elementos predictivos de mortalidad en estos pacientes. Conclusiones: El abordaje integral de la neutropenia febril incluye además de una evaluación clínica y humoral exquisita, la aplicación de herramientas pronósticas para la estratificación de riesgo de cada paciente. El tratamiento de los pacientes debe comenzar en la primera hora de haberse documentado la fiebre, ya que las infecciones pueden ser rápidamente progresivas con un alto riesgo de desarrollo de sepsis, inestabilidad hemodinámica y disfunción multiorgánica(AU)


Introduction: Febrile neutropenia frequently affects patients with hematological malignancies and constitutes a medical emergency. Its therapeutic management is a real challenge at present, due to the appearance of infections caused by multiresistant microorganisms and the coexistence of patient- and treatment-dependent factors leading to risk for serious complications. Methods: An exhaustive review was conducted about the topic in the main databases of the Virtual Health Library, for which papers mainly published in the last five years were used as reference. Data analysis and synthesis: A diagnostic and therapeutic approach was applied to the study of patients at high risk for complications due to bacterial infections and their comprehensive evaluation. Recent tools to screen sepsis and sepsis-related organ damage are included which constitute mortality prediction elements in these patients. Conclusions: Comprehensive management of febrile neutropenia includes not only a detailed clinical and humoral evaluation, but also the application of prognostic tools for risk stratification in each patient. Patient treatment should be started within the first hour after fever documentation, since infections may be rapidly progressive with a high risk for the development of sepsis, hemodynamic instability and multiple organ dysfunction(AU)


Subject(s)
Humans , Febrile Neutropenia/diagnosis , Neutropenia/drug therapy , Hematologic Diseases/diagnosis
3.
Rev. méd. Maule ; 33(2): 20-24, sept. 2018. tab
Article in Spanish | LILACS | ID: biblio-1292505

ABSTRACT

The term autoimmune cytopenias is referred to a heterogeneous group of diseases characterized by a reduced peripheral blood cell counts in one or more cellular series, because an immunological disorder. The first line therapy is steroids, followed by splenectomy or immunesupressant therapy in non-responders. Rituximab is an anti CD20 monoclonal antibody used as a third line in refractory patients or as an alternative to splenectomy. We present a retrospective study of nine patients with autoimmune cytopenias treated in a public hospital setting with rituximab. Five patients with the diagnosis of inmune thrombocytopenic purpura received it, all of them achieved hematological response (4 complete and one partial). The median time to the best response was 6 weeks, staying in this category after 6 months of follow up. Four patients with autoimmune hemolytic anemia received rituximab, three of them achieving partial response and one was lost from follow up. No severe adverse effects related to rituximab were registered.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Autoimmune Diseases/drug therapy , Thrombocytopenia/drug therapy , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Immunologic Factors/therapeutic use , Anemia, Hemolytic, Autoimmune/drug therapy , Neutropenia/drug therapy , Retrospective Studies , Purpura, Thrombocytopenic, Idiopathic/immunology , Rituximab/administration & dosage
4.
Rev. chil. infectol ; 35(4): 448-452, ago. 2018. graf
Article in Spanish | LILACS | ID: biblio-978057

ABSTRACT

Resumen Presentamos el caso clínico de un paciente con una leucemia linfoblástica aguda (LLA) que desarrolló una fusariosis diseminada por Fusarium verticillioides durante un episodio prolongado de neutropenia febril post quimioterapia. Fue exitosamente tratado cuando se usó terapia combinada de voriconazol más anfotericina B deoxicolato.


We report a case of a patient with acute lymphoblastic leukemia (ALL), who developed a disseminated infection by Fusarium verticillioides during chemotherapy-induced neutropenia. He was successfully treated only after combination therapy with voriconazole plus amphotericin B deoxycolate was used, but not when these compounds were used in an isolated form.


Subject(s)
Humans , Male , Adolescent , Amphotericin B/therapeutic use , Deoxycholic Acid/therapeutic use , Fusariosis/drug therapy , Voriconazole/therapeutic use , Antifungal Agents/therapeutic use , Neutropenia/drug therapy , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Drug Combinations , Drug Therapy, Combination , Fusariosis/etiology , Fusariosis/pathology , Neutropenia/etiology , Neutropenia/pathology
5.
Rev. chil. infectol ; 30(2): 195-201, abr. 2013. tab
Article in Spanish | LILACS | ID: lil-673998

ABSTRACT

Background: Febrile neutropenia (FN) is a significant adverse effect post-chemotherapy due to its high morbidity and mortality. There are few studies in our country with these kind of patients. Objective: To describe the characteristics and mortality in patients with hematologic neoplasms who developed FN post-chemotherapy. Methodology: A descriptive case series in patients with hematologic neoplasms who developed FN post-chemotherapy in Hospital Pablo Tobón Uribe. Results: 101 episodes of FN in 43 patients. The median age was 44 years. 63.5% of patients had no apparent clinical focus of infection at admission, 11.8% had soft tissue compromise and 8.9% urinary tract infection. Bacteremia was documented in 41.5% and catheter-associated bacteremia in 3.9%. The most common organisms were Escherichia coli 43.4%, Klebsiella pneumoniae 17.3% and Staphylococcus aureus 8.6%. Of those isolated in blood 84.7% were Gram negative rods and 15.2% were Gram positive bacteria. Piperacillin/tazobactam was the most common empirically prescribed antibiotic (81.1%). Mortality of FN episodes occurred in 8 (7.92%) patients, 5 (62.5%) attributable to infection and 3 (37.5%) due to progression of hematologic malignancy with a resolution of FN. Conclusions: In our case series of FN the microbiological characteristics differed significantly from developed countries, but a similar mortality rate per episode was observed.


Introducción: La neutropenia febril (NF) es un efecto adverso importante post-quimioterapia por su alta morbi-mortalidad. Hay pocos estudios en nuestro entorno con estos pacientes. Objetivo: Describir las características de los pacientes adultos con neoplasia hematológica que desarrollaron NF post-quimioterapia. Metodología: Estudio descriptivo de serie de casos, en pacientes con neoplasia hematológica y NF post-quimioterapia en el Hospital Pablo Tobón Uribe. Resultados: Ciento un episodios de NF en 43 pacientes con una mediana de edad de 44 años. El 63,5% no tenían foco infeccioso clínico aparente al ingreso, 11,8% tenía compromiso de tejidos blandos y 8,9% foco urinario. Se documentó bacteriemia primaria en 42 (41,5%) y bacteriemia asociada al catéter en 4 (3,96%). Los microorganismos más frecuentes fueron Escherichia coli 43,4%, Klebsiella pneumoniae 17,3% y Staphylococcus aureus 8,69%. De los aislados en sangre, 84,7% fueron bacilos gramnegativos y 15,2% cocáceas grampo-sitivas. Piperacilina/tazobactam fue la antibioticoterapia empírica inicial en 81,1% de los episodios. La mortalidad por episodios de NF fue de 7,92%, en 62,5% atribuible a la infección y en el resto a progresión de la neoplasia hematológica con resolución de la NF. Conclusión: Serie de casos de NF con características microbiológicas que difieren significativamente a los países desarrollados, pero con una mortalidad por episodios similar.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antineoplastic Agents/adverse effects , Bacterial Infections/epidemiology , Fever/epidemiology , Hematologic Neoplasms/drug therapy , Neutropenia/epidemiology , Antineoplastic Agents/therapeutic use , Colombia/epidemiology , Fever/drug therapy , Fever/etiology , Hematologic Neoplasms/complications , Neutropenia/chemically induced , Neutropenia/drug therapy
6.
Indian J Cancer ; 2012 Jan-Mar; 49(1): 107-113
Article in English | IMSEAR | ID: sea-144560

ABSTRACT

Background: In patients with persistent fever and netropenia, amphotericin B is administered empirically for early treatment and prevention of systemic fungal infections. Despite this treatment, there are chances of breakthrough fungal infections and drug is also toxic. Materials and Methods: A multicentric, randomized, controlled clinical trial was conducted to compare liposomal amphotericin B two doses with conventional amphotericin B as empirical antifungal therapy. Results: The average body weight of patients was 26.4±14.8 (n=22), 32.9±19.4 (n=23) and 37.9±20.0 (n=20) kg in 1 mg, 3 mg Fungisome (liposomal amphotericin B) and 1 mg/kg/day conventional amphotericin B group, respectively. The mean age was 16.2±13.4, 16.0±10.9 and 22.7±16.2 yrs in 1 and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional AMP B group, respectively. The average duration of treatment with 1 mg and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional amphotericin B was 17±9.8, 16.2±8.3, and 14.7±10.7 days, respectively. The time to resolve fever was 13.3±10.2, 10.9±7.1, 10.1±6.7 days, and for absolute neutrophil count (ANC) to be above 500 cells per microliter, it took 13.4±9.6, 10.6±7.6 and 7.3±3.4 days, respectively. Liposomal formulations were well-tolerated compared to conventional amphotericin B. Conclusions: This small randomized study showed that the indigenous liposomal formulation Fungisome TM appears to be equally efficacious and safer than conventional amphotericin B. Also, the lower dose Fungisome (1 mg/kg/day) appears to be equally efficacious and was well-tolerated as compared to higher dose Fungisome (3 mg/kg/day). Treatment cost would be a major factor for limiting use of higher dose of Fungisome.


Subject(s)
Adolescent , Adult , Amphotericin B/administration & dosage , Amphotericin B/adverse effects , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , India , Male , Middle Aged , Mycoses/drug therapy , Neutropenia/drug therapy , Neutropenia/pathology , Safety , Treatment Outcome
7.
Rev. chil. infectol ; 28(6): 537-545, dic. 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-612152

ABSTRACT

Febrile neutropenia is a serious complication of antineoplastic therapy and it is more commonly found in hematologic patients, associated with high mortality rates. Inadequate tissue concentration of antimicrobials has been described as a cause of therapeutic failure which also has been related to a low interstitial concentration for hydrophilic antibiotics. In critically ill patients it may occur an accumulation of compartmental fluids which can be related to an increase in the distribution volume or changes in clearance of antimicrobials. Pharmacokinetic and pharmacodynamic parameters of antimicrobials are reviewed, which can be used as a tool to optimize the efficacy of antimicrobial therapy in order to avoid failures and resistance selection.


La neutropenia febril es una complicación grave de la terapia antineoplásica que se presenta más frecuentemente en pacientes con neoplasias hematológicas, asociada a tasas elevadas de mortalidad. Uno de los factores descritos como causa de fracasos terapéuticos de la terapia antimicrobiana es la inadecuada concentración tisular de los antimicrobianos que a su vez se correlaciona con bajas concentraciones en el líquido intersticial en el caso de los fármacos hidrofílicos. En pacientes críticamente enfermos se puede presentar acumulación compartimental de líquidos que a su vez se puede asociar con aumento en el volumen de distribución de los medicamentos o alteraciones en la depuración de los mismos. Se revisan los parámetros farmacocinéticos y farmacodinámicos de los antimicrobianos que pueden ser usados como herramienta para optimizar la eficacia de la terapia antiinfecciosa en busca de disminuir la tasa de fracasos y la selección de cepas resistentes.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacokinetics , Bacterial Infections/metabolism , Fever/metabolism , Neutropenia/metabolism , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Critical Illness , Fever/drug therapy , Fever/etiology , Microbial Sensitivity Tests , Neoplasms/drug therapy , Neutropenia/drug therapy , Neutropenia/etiology
8.
Rev. méd. Chile ; 139(9): 1128-1134, set. 2011. tab
Article in Spanish | LILACS | ID: lil-612235

ABSTRACT

Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25 percent in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17 percent). According to diagnostic criteria, 5 percent of episodes corresponded to persistent fever , 1 percent and 11 percent of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18 percent. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antifungal Agents/administration & dosage , Itraconazole/administration & dosage , Leukemia, Myeloid, Acute/drug therapy , Mycoses/prevention & control , Neutropenia/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Acute Disease , Administration, Oral , Antifungal Agents/adverse effects , Aspergillosis/prevention & control , Fever/drug therapy , Itraconazole/adverse effects , Neutropenia/chemically induced , Prospective Studies , Pulmonary Aspergillosis/prevention & control
9.
Rev. cuba. farm ; 45(1): 19-33, ene.-mar. 2011.
Article in English | LILACS | ID: lil-584563

ABSTRACT

Neutropenia and infections are the most restrictive side effects during chemotherapy application. The granulocytic colonies stimulating factor activates the neutrophils, shortens the neutropenic period and can be effective against the potential risk of infection. The purpose of this study was to evaluate the efficacy and safety of LeukoCIM® (CIMAB, Havana). A retrospective observational study was carried out with data from the patients with neutropenic episodes enrolled in the open-label, non-randomized, multicenter, phase IV clinical trial. These patients were from Gustavo Aldereguía Lima hospital. They had been evaluated for one year. Demographic information, clinical data and side effects were analyzed. As prophylaxis indication LeukoCIM® was administrated 24-72 h after the last chemotherapy dose and as treatment when neutropenia was diagnosed. In both cases, a daily single 300 µg dose was administrated subcutaneously. The application of the next chemotherapy cycle on time was the main variable of response and the product safety was assessed by measuring the side effects. Forty seven patients with 95 neutropenic episodes were enrolled. The 82.1 percent of episodes received their next chemotherapy cycle on time. The most frequent side effects were: bone pain and fever (11.2 percent respectively), hyperuricemia (9.2 percent), leukocytosis and neutrophilia (7.1 percent) and increased LDH (6.1 percent). LeukoCIM® was effective in patients receiving chemotherapy, because it accelerated neutrophil recovery, decreased the incidence of febrile neutropenia and improved delivery of protocol doses of chemotherapy on time. Additionally, this product was considered safe for the studied patients since just known adverse events were reported


La neutropenia y las infecciones constituyen los eventos adversos más limitantes en la aplicación de quimioterapia. Los factores estimulantes de colonias de granulocitos activan los neutrófilos, acortan el periodo neutropénico y pueden ser efectivos contra los riesgos potenciales de infección. El propósito de este estudio fue evaluar la efectividad y seguridad del LeukoCIM® (CIMAB, La Habana). Se realizó un estudio retrospectivo, observacional con los datos de los pacientes incluidos en el ensayo clínico fase IV abierto, no aleatorizado y multicéntrico. Estos pacientes provenían del Hospital Gustavo Aldereguía Lima y se evaluaron durante un año. Se analizaron los datos demográficos, clínicos y de seguridad. Como profilaxis el fármaco fue administrado de 24-72 h después de la última dosis de quimioterapia y como tratamiento cuando la neutropenia había sido diagnosticada. En ambos casos la dosis única diaria fue de 300 µg por vía subcutánea. La administración del próximo ciclo de quimioterapia en tiempo resultó la variable principal de respuesta y la seguridad del producto se evaluó midiendo los eventos adversos. Se incluyeron 47 pacientes con 95 episodios neutropénicos. El 82,1 por ciento de episodios recibió su próximo ciclo de quimioterapia en tiempo. Los eventos adversos más frecuentes fueron: dolor óseo y fiebre (11,22 por ciento respectivamente), hiperuricemia (9,2 por ciento), leucocitosis y neutrofilia (7,1 por ciento) e incremento de LDH (6, 1 por ciento). LeukoCIM® resultó efectivo, pues aceleró la recuperación del número de neutrófilos, disminuyó la incidencia de neutropenia febril y permitió administrar las dosis de quimioterapia en tiempo según el protocolo. También se consideró seguro en la serie estudiada, pues solo reportó eventos adversos conocidos


Subject(s)
Clinical Trials as Topic , Neutrophils/pathology , Neutropenia/drug therapy , Reference Drugs
10.
West Indian med. j ; 60(2): 153-157, Mar. 2011. ilus, tab
Article in English | LILACS | ID: lil-672742

ABSTRACT

OBJECTIVES: To evaluate the incidence, presentation, treatment and outcome of febrile neutropenic episodes of patients treated at the Wendy Fitzwilliam Paediatric Hospital (WFPH) in Trinidad and Tobago. METHODOLOGY: Using a retrospective cohort method, the records of all the patients registered at the Paediatric Oncology Unit at The WFPH, receiving chemotherapy for haematological or solid tumour malignancies from May 2001 to April 2008 and having episodes of febrile neutropenia were analysed. RESULTS: Seventy one episodes of febrile neutropenia were analysed from the 36 patient records. Episode frequency ranged from 1 to 5. The mean duration of febrile neutropenic episodes was 5. 01 days (± SD 5. 2), with range from 1 - 25 days. Acute Lymphoblastic Leukaemia (ALL) accounted for 43. 7%. The mean WBC for the study population was 0. 88 x 10(9)/L (± SD 0. 61), with the mean absolute neutrophil count (ANC) at 0. 16 x 10(9)/L (± SD 0. 23). Antifungal therapy was used in 6 cases and the incidence of blood culture positive sepsis was 8. 5%. Complete resolution occurred in 65 episodes CONCLUSIONS: Febrile neutropenia episodes treated at the WFPH have a very favourable outcome (91. 5%). The further analysis of the relationships found in this study between the total white blood cell count at presentation and the duration of antimicrobial therapy, the duration of the febrile neutropenic episodes and outcome is needed.


OBJETIVO: Evaluar la incidencia, presentación, tratamiento y evolución clínica de los episodios neutropénicos febriles de pacientes tratados en el Hospital Pediátrico Wendy Fitzwilliam (WFPH) en Trinidad y Tobago. METODOLOGÍA: Mediante un método de cohorte retrospectivo, se analizaron las historias clínicas de todos los pacientes inscritos en la Unidad de Oncología Pediátrica en WFPH, que recibieron quimioterapia para el tratamiento de neoplasias hematológicas o tumores malignos sólidos desde mayo de 2001 a abril de 2008 y tuvieron episodios de neutropenia febril. RESULTADOS: Se analizaron setenta y un episodios de neutropenia febril de las historias clínicas de 36 pacientes. La frecuencia de los episodios osciló entre 1 y 5. La duración promedio de los episodios neutropénicos febriles fue 5. 01 días (± SD 5. 2), con un rango de 1 a 25 días. La leucemia linfoblástica aguda (LLA) representó el 43, 7% de los casos. El promedio del conteo de glóbulos blancos (WBC) para la población de estudio fue 0. 88 X 10(9)/L (± SD 0, 61), con el promedio del conteo absoluto de neutrófilos (CAN) en 0. 16 X 10(9)/L (± SD 0. 23). La terapia antifúngica fue utilizada en 6 casos y la incidencia de la sepsis confirmada por cultivo positivo de la sangre fue 8. 5%. En 65 episodios (91. 5%) hubo resolución completa con 6 muertes. CONCLUSIONES: Los episodios de neutropenia febril tratados en la WFPH tienen una evolución clínica muy favorable (91. 5%). Se necesita profundizar en el análisis de las relaciones encontradas en este estudio entre el conteo total de glóbulos blancos en la presentación y la duración del tratamiento con antibióticos, la duración de los episodios neutropénicos febriles y la evolución clínica.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Fever/drug therapy , Neoplasms/complications , Neutropenia/drug therapy , Anti-Bacterial Agents/therapeutic use , Fever/complications , Neoplasms/drug therapy , Neutropenia/complications
12.
Lima; s.n; 2011. 78 p. tab, graf.
Thesis in Spanish | LILACS, LIPECS | ID: lil-682726

ABSTRACT

El presente estudio titulado "Relación entre los conocimientos sobre neutropenia post quimioterapia y actitudes frente al tratamiento en adolescentes del Instituto Nacional de Enfermedades Neoplásicas-2010", cuyo objetivo fue determinar la relación entre los conocimientos sobre neutropenia post quimioterapia y actitudes frente al tratamiento en adolescentes de! INEN. Material y métodos: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo correlacional, de corte transversal. La población estuvo conformada por 15 pacientes adolescentes de ambos sexos con neutropenia post quimioterapia hospitalizados en las salas de neutropenia del Servicio de Adolescentes "3ero E" del INEN. El instrumento utilizado fue la técnica de la encuesta y 2 instrumentos: un cuestionario sobre conocimientos y Escala de Lickert sobre las actitudes. Resultados: Los conocimientos sobre neutropenia post quimioterapia que tienen los adolescentes es mayormente medio (53.3 por ciento), con tendencia a bajo (13.4 por ciento) y porcentaje considerable alto (33.3 por ciento). Las actitudes frente al tratamiento de la neutropenia post quimioterapia es mayormente de indecisión (66.7 por ciento), con tendencia a aceptación (13.4 por ciento) y un porcentaje considerable de rechazo (20 por ciento). No existe relación entre el nivel de conocimientos sobre neutropenia post quimioterapia y actitudes frente al tratamiento en adolescentes del INEN, (33.3 por ciento) tienen nivel de conocimiento medio y actitud de indecisión, (20 por ciento) tienen conocimiento bajo y una actitud de rechazo y sólo el (13.4 por ciento) un nivel de conocimiento alto con una actitud de aceptación (X2 PRUEBA=31.88 > X2 TABLA=23.69). Conclusiones: No existe relación entre los conocimientos sobre neutropenia post quimioterapia y actitud de los pacientes adolescentes del INEN.


This study entitled "Relationship between post chemotherapy neutropenia knowledge and attitudes to treatment in adolescents from the National Institute of Neoplastic Diseases-2010" whose objective was to determine the relationship between post chemotherapy neutropenia knowledge and attitudes to treatment in adolescents the INEN. Methods: The study was application-Ievel, quantitative, descriptive correlational method, cross-sectional. The population consisted of 15 adolescent patients of both sexes with post chemotherapy neutropenia hospitalized in the halls of the Adolescent Service neutropenia "3rd E" INEN. The instrument used was the technique of the survey and 2 instruments: a questionnaire on knowledge and Likert Scale on attitudes. Results: Knowledge of post chemotherapy neutropenia among adolescents is mostly half (53.3 per cent), prone to low (13.4 per cent) and considerable high percentage (33.3 per cent). Attitudes towards the treatment of post chemotherapy neutropenia of indecision is mostly (66.7 per cent), with a tendency to accept (13.4 per cent) and a considerable percentage of rejection (20 per cent). There is no relationship between the level of neutropenia post chemotherapy knowledge and attitudes to treatment in adolescents INEN (33.3 per cent) have level of knowledge and attitude of indecision (20 per cent) have low awareness and an attitude of rejection and only the (13.4 per cent) ha ve a high level of knowledge with an attitude of acceptance (X2 PRUEBA=31.88 > X2 TABLA=23.69). Conclusions: There is no relationship between post chemotherapy neutropenia knowledge and attitude of adolescent patients of INEN.


Subject(s)
Humans , Male , Adolescent , Adult , Female , Adolescent, Hospitalized , Adolescent Behavior , Neutropenia/drug therapy , Cross-Sectional Studies
14.
Yonsei Medical Journal ; : 616-623, 2011.
Article in English | WPRIM | ID: wpr-33258

ABSTRACT

PURPOSE: The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (Ctrough) and microorganism-specific (AUC24/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever. MATERIALS AND METHODS: One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC >125 [or 345] using logistic analysis. RESULTS: The standard dose regimen of teicoplanin showed TARs of about 70% [or 33%] and 70% [or 20%] at steady-state in cases with AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L, respectively. CONCLUSION: The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Computer Simulation , Dose-Response Relationship, Drug , Fever/drug therapy , Humans , Microbial Sensitivity Tests , Neutropenia/drug therapy , Republic of Korea , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Teicoplanin/administration & dosage , Treatment Outcome
15.
Indian J Cancer ; 2010 Oct-Dec; 47(4): 430-436
Article in English | IMSEAR | ID: sea-144384

ABSTRACT

Background: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.


Subject(s)
Adolescent , Adult , Aged , Anti-Infective Agents/economics , Anti-Infective Agents/therapeutic use , Cohort Studies , Female , Granulocyte Colony-Stimulating Factor/economics , Granulocyte Colony-Stimulating Factor/therapeutic use , Hospitals , Humans , India , Male , Middle Aged , Neoplasms/complications , Neutropenia/drug therapy , Neutropenia/etiology , Practice Patterns, Physicians'/statistics & numerical data , Young Adult
16.
Rev. méd. Maule ; 26(2): 110-114, sept. 2010. tab
Article in Spanish | LILACS | ID: lil-574222

ABSTRACT

Introducción: Fiebre de Origen Desconocido (FOD) es una entidad clínica poco prevalente y amplio es el repertorio patologías conocidas como causales. Caso clínico. Se describe el caso de una mujer de 43 años, hipertensión arterial y "sífilis" tratada en 1994. Dos meses con Síndrome Febril Prolongado, baja de peso, poliartritis y compromiso del estado general progresivo, vómitos y diarrea. Destacaba en el examen físico temperatura axilar de 39°C, candidiasis oral, evidentemente enflaquecida y sensibilidad difusa del abdomen sin signos de alarma. Estudio revelo neutropenia febril y parámetros inmunológicos alterados, compatibles con Lupus Eritematoso Sistémico. Discusión.


Subject(s)
Humans , Adult , Female , Fever of Unknown Origin/etiology , Lupus Erythematosus, Systemic/complications , Neutropenia/complications , Neutropenia/drug therapy , Anti-Bacterial Agents/therapeutic use , Fever/drug therapy
17.
Rev. bras. hematol. hemoter ; 32(5): 402-408, 2010. tab
Article in Portuguese | LILACS | ID: lil-571640

ABSTRACT

A neutropenia febril (NF) é uma complicação frequente e potencialmente fatal nos pacientes em tratamento quimioterápico. Entendemos hoje que a neutropenia febril é considerada uma emergência clínica e que a administração de antibióticos de amplo espectro diminui drasticamente a mortalidade. Estudos sugerem que a neutropenia febril compreende um grupo extremamente heterogêneo e que dados clínicos como febre domiciliar, ausência de hipotensão, ausência de desidratação, ausência de doença pulmonar obstrutiva crônica, ausência de outros sintomas, ausência de infecção fúngica prévia e idade < 60 anos são fatores de proteção para complicações clínicas graves segundo o estudo da Multinational Association for Supportive Care of Cancer (MASCC). Estes dados permitem maior segurança para o tratamento ambulatorial e alta precoce, uma vez que estudos fármaco-econômicos demonstram importante redução de custos no tratamento ambulatorial da neutropenia febril. O objetivo desta revisão é discutir instrumentos de segurança da triagem de um paciente neutropênico febril (principalmente pela utilização do índice MASCC), como também demonstrar as formas descritas na literatura do tratamento ambulatorial e seus resultados.


Febrile neutropenia is a frequent and potentially fatal adverse event of chemotherapy. Nowadays, febrile neutropenia is considered an emergency and it is known that prompt infusion of antibiotics decreases mortality. Several studies demonstrated that febrile neutropenia is a heterogeneous group of diseases and that factors such as outpatient status, no hypotension, no dehydration, no chronic obstructive pulmonary disease, no symptoms, no previous fungal infection and age < 60 years are protective factors against serious complications as demonstrated by the Multinational Association for Supportive Care in Cancer (MASCC). These data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. The aim of this work is to review and discuss tools (in particular the MASCC index) for safe screening of febrile neutropenia for outpatient treatment in addition to demonstrate results of research.


Subject(s)
Humans , Ambulatory Care , Anti-Bacterial Agents/therapeutic use , Fever , Neutropenia/drug therapy , Risk Factors , Triage
18.
J. pediatr. (Rio J.) ; 85(6): 531-535, nov.-dez. 2009. tab
Article in Portuguese | LILACS | ID: lil-536183

ABSTRACT

OBJETIVO: Comparar o uso de antibioticoterapia endovenosa versus oral. MÉTODOS: Foram selecionadas todas as crianças e adolescentes neutropênicos com idade inferior a 18 anos classificados como baixo risco para complicações e recebendo quimioterapia. O estudo ocorreu entre 2002 e 2005 na Unidade de Oncologia Pediátrica, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS). Os pacientes, divididos em grupo A e grupo B, eram randomizados para receber terapia oral ou endovenosa. O tratamento utilizado para o grupo A foi ciprofloxacina e amoxicilina/clavulanato via oral e placebo endovenoso e, para o grupo B, cefepime e placebo oral. RESULTADOS: Foram selecionados 91 episódios consecutivos de neutropenia febril em 58 crianças. Para os pacientes do grupo A, a taxa de falência foi de 51,2 por cento e a média de tempo de hospitalização foi de 8 dias (variação de 2-10). Para os pacientes tratados com antibioticoterapia endovenosa, a taxa de falência foi de 45,8 por cento e a média de tempo de hospitalização foi de 7 dias (variação de 3-10). CONCLUSÃO: Neste estudo não houve diferenças entre a antibioticoterapia oral versus a terapia endovenosa. Estudos randomizados com maior número de pacientes são necessários antes de padronizar a terapêutica oral como tratamento para esta população de pacientes.


OBJECTIVE: To compare the use of intravenous vs. oral antibiotic therapy. METHODS: All febrile neutropenic patients younger than 18 years old with low risk of complications and receiving chemotherapy were selected. The study was conducted from 2002 to 2005 at the Pediatric Oncology Unit of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Patients were divided into group A and group B and were randomly assigned to receive oral or intravenous therapy. The empirical antimicrobial treatment used for group A consisted in oral ciprofloxacin plus amoxicillin-clavulanate and intravenous placebo, and group B received cefepime and oral placebo. RESULTS: A total of 91 consecutive episodes of febrile neutropenia in 58 children were included in the study. For patients of group A, treatment failure rate was 51.2 percent; the mean length of hospital stay was 8 days (range 2-10 days). For patients treated with intravenous antibiotic therapy, treatment failure rate was 45.8 percent; the mean length of hospital stay was 7 days (range 3-10 days). CONCLUSION: There was no difference in the outcome in oral vs. intravenous therapy. There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment.


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Neoplasms/drug therapy , Neutropenia/drug therapy , Administration, Oral , Epidemiologic Methods , Injections, Intravenous , Length of Stay , Neutropenia/mortality
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