Antibiotic lock solutions allow less systemic antibiotic exposure and less catheter malfunction without adversely affecting antimicrobial resistance patterns.

There are current concerns that antibiotic lock solutions (ABL) can induce antimicrobial resistance in long-term hemodialysis patients. Retrospective chart review of 157 children on hemodialysis between January 1997 and June 2006 was performed. In ERA I, only systemic antibiotics were used. In ERA II, ABL were added to systemic antibiotics when needed. In ERA III, ABL were used for treatment of all cases of catheter-related bacteremia (CRB) and for CRB prophylaxis in high-risk patients. The study includes 111,325 catheter days. The CRB incidence was 3.9 CRB/1000 catheter days. There was significant decrease for the total systemic antibiotic exposure (P = 0.0484) and the percentage of catheters lost to malfunction (P = 0.001) in ERA III. Protocol ABL exposure was associated with a trend to increased tobramycin-gentamicin resistance for gram-positive CRBs (P = 0.2586) but with improved tobramycin-gentamicin resistance for gram-negative (P = 0.0949) and polymicrobial CRBs (P = 0.1776) and improved vancomycin resistance for gram-positive CRBs (P = 0.0985). This retrospective analysis does not support the premise that ABL use will promote antimicrobial resistance in the hemodialysis population. The decreased exposure to systemic antibiotics by vigorous ABL use may even improve the antimicrobial resistance patterns in this population in the long term.

Comparison of early versus late use of antibiotic locks in the treatment of catheter-related bacteremia.

BACKGROUND AND OBJECTIVES: This retrospective study compared the effectiveness of the timing of the antibiotic locks to clear catheter-related bacteremia in children on chronic hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The early antibiotic lock group received antibiotic locks along with systemic antibiotics from the very beginning of catheter-related bacteremia. The late antibiotic lock group was given only systemic antibiotics initially, and antibiotic locks were used late in the infection if the catheter-related bacteremia could not be cleared after resolution of symptoms. RESULTS: There were 264 catheter-related bacteremias in 79 children during 6 yr of observation. Early antibiotic locks were able to clear catheter-related bacteremia and resolve the symptoms more effectively without the need for catheter exchange when compared with late antibiotic locks. A total of 84 catheter-related bacteremias required wire-guided exchange of the catheters. Late antibiotic locks required wire-guided catheter exchange more frequently than the early antibiotic locks. The post-catheter-related bacteremia infection-free survival of the catheters after wire-guided exchange were significantly longer than those of both antibiotic lock groups. Recurrence of catheter-related bacteremia within 45 d after wire-guided exchange occurred at similar rates compared with the antibiotic lock groups. CONCLUSION: Antibiotic locks are significantly more effective in clearing catheter-related bacteremia when used early in infection, diminishing the need for catheter exchange. Wire-guided exchange has a late-onset advantage for infection-free survival compared with catheter in situ treatment. The recurrence rates in the first 45 d after catheter-related bacteremia are similar regardless of the treatment strategy.

Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy.

The response to secondary therapy, chemotherapy or hormonal, is examined in 26 patients with adenocarcinoma of breast who failed adjuvant chemotherapy. Response rates to tamoxifen or combination chemotherapy, cyclophosphamide, methotrexate, and 5-FU (CMF) or Adriamycin and vincristine (AV) were similar to response rates reported for Stage IV patients, never exposed to cytotoxic agents. Survivals in these 26 patients were similar to those reported for Stage IV patients never exposed to cytotoxics. It is concluded that adjuvant chemotherapy does not lessen future response to secondary therapies or decrease survival.

Multimodality therapy of stage III adenocarcinoma of the breast.

The results of a pilot multimodality program (surgery + radiotherapy + chemotherapy) are reported in 34 women with advanced stage III and IV adenocarcinoma of the breast. The median relapse-free survival for all patients was 24 months, with 74% of the premenopausal patients and 37% of the postmenopausal alive at five years (P = 0.18). The relapse rate was significantly lower in premenopausal patients when compared to the postmenopausal subgroup. Estrogen receptor status was not predictive for relapse or survival.

Acute nephrotoxicity following cis-dichlorodiammine-platinum.

The effects of a single dose of cis-diamminedichloroplatinum (DDP) on the kidney function were investigated in 14 patients with disseminated malignancy and normal renal function. A single dose of DDP (30-50 mg/m2) caused severe proximal tubular dysfunction with increased urinary losses of calcium, magnesium, and amino acids. Phosphate excretion was not affected. DDP can cause proximal tubular dysfunction and close attention must be paid to serum calcium and magnesium levels.

Prognostic value of the estrogen receptor level in pathologic stage I and II adenocarcinoma of the breast.

The relationship between estrogen receptor levels and recurrence of breast cancer was examined in 302 patients with adenocarcinoma of the breast, pathologic stage (PS) I and II. All 117 patients with PS II adenocarcinoma of the breast received adjunctive chemotherapy. In this series, there was no association between the estrogen receptor level and recurrence in either the 185 patients with PS I adenocarcinoma of the breast or the 117 patients with PS II adenocarcinoma of the breast. The most important prognostic variable was the presence or absence of axillary metastases.

Melphalan, vincristine, and 5-FU in advanced colonic carcinoma: results of a pilot study.

The results of treatment with melphalan, vincristine, and 5-FU (MVF) in 32 patients with advanced colonic carcinoma are reported. The objective response rate among 31 patients with measurable disease was 16% (five patients responded). The projected survival for all 32 patients was 277 days. Patients with objective response to MVF had a projected survival of 314 days, significantly longer than the survival of patients with no response to therapy, 84 days (P = 0.01). While toxic effects were mild with MVF, this regimen appears to have greater activity in advanced colonic carcinoma than therapy with 5-FU alone or in combination with nitrosoureas.

Intracavitary bleomycin for the control of malignant effusions.

The results of treatment with intracavitary bleomycin are reported in twenty patients with a malignant pleural effusion and five patients with malignant ascites. The control rate was 17/20 (85%) patients with malignant pleural effusions and 3/5 (60%) patients with malignant ascites. Toxicities were minimal with fever being the most common side effect in four patients (16%. Bleomycin is an effective and nontoxic sclerosing agent.

Treatment of metastatic pancreatic and gastric adenocarcinomas with 5-fluorouracil, adriamycin, and mitomycin C (FAM).

Twenty-six patients with metastatic pancreatic or gastric adenocarcinoma were treated with 5-fluorouracil, Adriamycin, and mitomycin C. One complete and five partial responses were observed among 15 patients with pancreatic adenocarcinoma (40% response rate) and six partial responses were observed among 11 patients with gastric adenocarcinoma (55% response rate). Responders had a significantly longer survival than nonresponders in both groups.

Marihuana-induced antibody response.

Utilizing an indirect Coombs' technique, humoral antibodies to marihuana and its major components were found in 34 subjects with known marihuana exposure. Similar antibodies were absent in the sera of a control population of 34 subjects with no known marihuana exposure. The specificity of the antibodies was confirmed by differential absorption studies in six seropositive subjects. Routine laboratory tests were abnormal in 22 of 34 seropositive subjects and in 9 of 34 control subjects. The relationship of seropositivity to abnormal laboratory tests is not certain.