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1.
J Vasc Interv Radiol ; 30(12): 1895-1900, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31668968

ABSTRACT

PURPOSE: To assess the infection rate after eliminating postprocedural antibiotics in patients undergoing hepatic artery embolization (HAE) for primary and secondary hepatic malignancies. MATERIAL AND METHODS: In this historical cohort study, adults ≥18 years of age without prior biliary instrumentation or bypass who underwent HAE and received pre- and postprocedure antibiotic prophylaxis between September 1, 2014, and August 31, 2015, comprised group A, whereas similar patients receiving only preprocedure antibiotic prophylaxis between October 1, 2015, and September 30, 2016, comprised group B. Procedures conducted between September 1, 2015, and September 30, 2015, were excluded. The primary outcome was any infection occurring within 30 days of HAE. RESULTS: A total of 150 patients underwent 204 HAE procedures in group A, and 171 patients underwent 221 procedures in group B. Cefazolin given as a 1-g dose (or 2 grams if obese) was administered in 391 of 425 evaluable procedures (92%). Clindamycin plus gentamicin was prescribed in 34 patients (8%) who had severe penicillin allergy. There was significant improvement in adherence to the postprocedure antibiotic regimen, from 68% (138 of 204 procedures) to 98% (216 of 221 procedures) (P < .001) with elimination of postprocedure prophylaxis. There were no significant differences in 30-day infection rates (5 [3%] vs. 5 [2%]; P = .57), hospital readmissions (13 [6%] vs. 12 [5%]; P = .68), or all-cause mortality (3 [1%] vs. 3 [1%]; P = .62) between the 2 groups. CONCLUSIONS: Elimination of postprocedural antibiotics after HAE did not lead to an increase in infectious complications. This finding supports the 2018 Society of Interventional Radiology recommendation for preprocedural prophylaxis only for HAE in the setting of an intact sphincter of Oddi.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis , Antimicrobial Stewardship , Bacterial Infections/prevention & control , Embolization, Therapeutic/adverse effects , Hepatic Artery , Liver Neoplasms/therapy , Unnecessary Procedures , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/adverse effects , Antibiotic Prophylaxis/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/microbiology , Bacterial Infections/mortality , Drug Administration Schedule , Embolization, Therapeutic/mortality , Female , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Patient Readmission , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young Adult
2.
J Antimicrob Chemother ; 72(8): 2355-2358, 2017 08 01.
Article in English | MEDLINE | ID: mdl-28475803

ABSTRACT

Objectives: The association of posaconazole serum concentrations and toxicity is unclear. An assessment of whether levels obtained with the delayed-release tablet (DRT) formulation are correlated with abnormal liver function test (LFT) results and/or QTc prolongation was undertaken. Methods: This was a multicentre, retrospective, observational study of adult patients with cancer between 26 November 2013 and 14 November 2014. Patients were included if they received posaconazole DRT with a posaconazole level obtained between days 5 and 14. Clinical data, including demographics, hepatotoxic medications, posaconazole levels, LFTs and QTc intervals, were obtained. Association of factors with changes in LFTs and QTc prolongation was assessed using linear and logistic regression. Results: One hundred and sixty-six study patients were included. The median posaconazole level was 1250 (range 110-4220) ng/mL and the median time until level was 6 (range 5-14) days. There was a statistically significant increase in AST ( P < 0.001), ALT ( P < 0.001), alkaline phosphatase (ALK) ( P < 0.001), total bilirubin (TBILI) ( P < 0.001) and QTc ( P = 0.05) from baseline. Posaconazole levels were not associated with increases in AST [ß (SE) = -0.33 (2.2), P = 0.88], log ALT [ß (SE) = -0.02 (0.03), P = 0.63], ALK [ß (SE) = 2.2 (2.9), P = 0.46] and TBILI [ß (SE) = -0.01 (0.04), P = 0.88]. For each additional hepatotoxic medication, there was a mean change in TBILI of 0.13 mg/dL ( P = 0.02) and ALK of 7.1 U/L ( P = 0.09). No statistically significant association between posaconazole level and QTc interval prolongation was found. Conclusions: We did not identify an association between posaconazole serum concentrations and LFT elevations or QTc prolongation. However, some LFTs were found to increase with more hepatotoxic medications administered.


Subject(s)
Antifungal Agents/adverse effects , Antifungal Agents/pharmacokinetics , Arrhythmias, Cardiac/epidemiology , Chemical and Drug Induced Liver Injury/epidemiology , Delayed-Action Preparations/adverse effects , Delayed-Action Preparations/pharmacokinetics , Triazoles/adverse effects , Triazoles/pharmacokinetics , Adolescent , Adult , Aged , Aged, 80 and over , Antifungal Agents/administration & dosage , Delayed-Action Preparations/administration & dosage , Electrocardiography , Female , Humans , Liver Function Tests , Male , Middle Aged , Retrospective Studies , Serum/chemistry , Tablets/administration & dosage , Tablets/adverse effects , Tablets/pharmacokinetics , Triazoles/administration & dosage , Young Adult
3.
J Infect ; 73(4): 336-45, 2016 10.
Article in English | MEDLINE | ID: mdl-27404978

ABSTRACT

OBJECTIVES: To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies. METHODS: We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case. RESULTS: CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior ß-lactam/ß-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08). CONCLUSIONS: CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population.


Subject(s)
Bacteremia/epidemiology , Enterobacteriaceae Infections/complications , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/drug effects , Hematologic Neoplasms/complications , Neutropenia/complications , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Carbapenems/pharmacology , Case-Control Studies , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Female , Humans , Male , Middle Aged , New York City/epidemiology , Prevalence , Risk Factors , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Young Adult , beta-Lactam Resistance
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