Microbiological findings in febrile neutropenia.

BACKGROUND: This study was carried out to assess the isolation rate of bacterial and fungal causative agents in Mexican neutropenic adults with hematological neoplasia. METHODS: A prospective observational survey involving 120 consecutive episodes of febrile neutropenia during 1 year was carried out. These episodes were observed in 630 patients discharged with diagnoses of leukemia or lymphoma, or after bone-marrow transplantation. RESULTS: At least one pathogen was isolated in 42 of 120 episodes (35%), and was present in 39 patients with acute myeloid leukemia (AML) (43%), acute lymphoblastic leukemia (ALL) (23%), and in patients who underwent bone-marrow transplantation (20%). Primary bacteremia was the most frequent cause of fever (24 episodes, 57%), followed by intravascular device-related infections (5 episodes, 17%), and soft-tissue infections (5 episodes, 15%). Escherichia coli (33%) was the most frequently isolated agent of primary bacteremia, followed by coagulase-negative Staphylococcus (29%), and Klebsiella oxytoca (16%). Fungal infection was responsible for five events (4%): two episodes of pneumonia (Penicillium marneffei and Aspergillus fumigatus, one event each); two cases of fungemia, one due to Candida tropicalis and one to Rhodotorula gluttinis, and one cryptococcal meningitis event. CONCLUSIONS: The isolation rate, approximately 30%, was in accordance with previous reports; similar percentages of Gram-positive and Gram-negative isolates were found. A remarkably low rate of viridans group streptococci and fungal agents was observed, despite the fact that neutropenia is the main risk factor for infection due to these agents. Studies reporting local microbiological findings are necessary because they support an antibiotic choice for prophylaxis or therapy more accurately than reports from other areas.

Characterization of the potentiation of the antinociceptive effect of diclofenac by vitamin B complex in the rat.

The role of vitamin B complex preparations as an analgesic adjuvant is controversial. Therefore, the purpose of the present study was to characterize the potentiation of the antinociceptive effect of diclofenac by a vitamin B complex preparation and its individual components by using the pain-induced functional-impairment model in the rat (PIFIR). Pain was produced by the intraarticular injection of uric acid in the right hind limb. Oral administration of diclofenac resulted in a dose-dependent antinociceptive effect. Oral administration of a vitamin B complex preparation containing thiamine (vitamin B(1)), pyridoxine (vitamin B(6)), and cyanocobalamin (vitamin B(12)) in a 1:1:0.01 proportion did not produce any antinociception by itself, but it significantly potentiated the effect of diclofenac. Coadministration of diclofenac with either thiamine or pyridoxine resulted in an antinociceptive effect similar to that of diclofenac alone. On the other hand, coadministration of cyanocobalamin significantly increased diclofenac-induced antinociception. It is concluded that the potentiation of diclofenac-induced antinociception in the PIFIR model is due to cyanocobalamin.