ABSTRACT
In 1983 our antibiotic regimen for suspected neonatal septicemia was changed from amoxicillin-gentamicin to cefotaxime-amoxicillin. During the subsequent 5-year period we studied the effect of this change in regimen on the bacterial flora of the infants in the unit and the occurrence of serious infections. This was done with bacteriologic surveillance and analysis of the positive blood cultures from 1978 through 1987. A change in the relative numbers of isolated pathogens was observed; Klebsiella sp. and Escherichia coli decreased whereas Enterobacter sp. increased. The susceptibility of the Enterobacter isolates to cefamandole decreased from 85.3% in 1982 to 52.9% in 1983. The susceptibility of these bacteria to cefotaxime was 55.2% in 1983 and 55.0% in 1987. No change in susceptibilities to cefotaxime, amoxicillin or gentamicin was found in other pathogens. Although colonization with Enterobacter strains has increased and the susceptibility of these bacteria to the cephalosporins has decreased, the incidence of serious infections with Gram-negative bacteria decreased.
Subject(s)
Amoxicillin/therapeutic use , Cefotaxime/therapeutic use , Enterobacteriaceae Infections/drug therapy , Intensive Care Units, Neonatal , Sepsis/drug therapy , Drug Resistance, Microbial , Enterobacter , Escherichia coli Infections/drug therapy , Female , Gentamicins/therapeutic use , Humans , Infant, Newborn , Klebsiella Infections/drug therapy , MaleABSTRACT
Four patients with acute myeloid leukemia (AML) were treated with high-dose cyclophosphamide and total body irradiation followed by reinfusion of a portion of their own bone marrow collected during remission. This procedure was applied when the patients were in complete remission. They did not receive further maintenance chemotherapy after grafting. The use of bone marrow for grafting that had been pre-exposed to high-dose chemotherapy for remission induction did not preclude good hematologic regeneration. All patients showed stable remissions that lasted for 64+, 21, 40+, and 19+ months, respectively. Death in the second patient was due to a medullary relapse of the leukemia. Autologous bone marrow transplantation in patients with AML in remission may permit lasting remissions, even when applied without additional chemotherapy and attempts to purify the marrow of neoplastic cells.
