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Reduced requirement for antibiotic therapy targeting Gram-negative organisms in febrile, neutropenic patients with cancer who are receiving antibacterial chemoprophylaxis with oral quinolones
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Oethinger M, Conrad S, Kaifel K, Comettta A, Bille J, Klotz G, Glauser MP, Marre R, the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer, Kern WV: Molecular epidemiology of fluoroquinolone-resistant Escherichia coli bloodstream isolates from patients admitted to European cancer centres. Antimicrob Agents Chemother 1996, 40:387-392. Pulse-field gel electrophoresis of quinolone-resistant E. coli isolated from blood cultures from cancer patients showed that strains were found to be distinguishable, and therefore the monoclonal spread of these organisms is unlikely. A third of strains, however, were not typable.
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GirmeniaC, Martino P, De Bernardis F, Gentile G, Boccanera M, Monaco M, Antonucci G, Cassone A: Rising incidence of Candida parapsilosis fungemia in hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains. Clin Infect Dis 1996, 23:506-514. C. parapsilosis caused 35 of 138 fungaemic episodes in an Italian cancer centre; the central venous catheter was the most common source of infection and catheter removal was required in many cases to effect a cure. C. parapsilosis was the most common species causing infection acquired at home during outpatient care. Certain strains, particularly those from patients with severe invasive disease, were shown to be more virulent than others in a mouse model. Approximately half of the strains were tolerant of fluconazole and itraconazole although full resistance was rare.
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Holt CD, Winston DJ, Kubak B, Imagawa DK, Martin P, Goldstein L, Olthoff K, Millis JM, Shaked A, Shackleton CR, Busuttil RW: Coccidioidomycosis in liver transplant patients. Clin Infect Dis 1997, 24:216-221. A review of 1347 liver transplant patients at UCLA (Los Angeles) showed that in this high-risk area for coccidioides infection eight patients (0.59%) developed disease. Any questioning of immunocompromised patients, including those due to receive chemotherapy or bone marrow transplantation, must include past geographical locations.
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Denning DW: Therapeutic outcome in invasive aspergillosis. Clin Infect Dis 1996, 23:608-615. This study analysed 1223 cases of invasive aspergillosis published in the world literature where more than three cases were reported. Crude mortality rates were 86, 66 and 99% for pulmonary, sinus and cerebral disease, respectively. If specific treatment could be given for more than 14 days, the response rate was 54% in leukaemic patients and only 33% in bone marrow transplant recipients. The mortality of cerebral aspergillosis was 99%. There was some evidence that mortality was lower in patients who were treated with itraconazole or lipid preparations of amphotericin B.
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Bart-Delabesse E, Marmorat-Khuong A, Costa JM, Dubreuil-Lemaire ML, Bretagne S: Detection of Aspergillus DNA in bronchoalveolar lavage fluid of AIDS patients by the polymerase chain reaction. Eur J Clin Microbiol Infect Dis 1996, 15:24-25.
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Cometta A, Calandra T, Gaya H, Zinner SH, de Bock R, Del Falvero A, Bucaneve G, Crokaert F, Kern WV, Klastersky J et al.: Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Infection Program. Antimicrob Agents Chemother 1996, 40:1108-1115. Meropenem was compared with ceftazidime-amikacin in 1034 patients with febrile neutropenia. There was no difference between the two groups with regard to any of the outcome measures, with successful treatment in 57 and 52% of patients receiving meropenem and ceftazidime-amikacin, respectively. Mortality was very low (eight and 13 deaths in each group, respectively). The study drugs were all very well tolerated, with few adverse reactions. Meropenem may be suitable for the management of febrile neutropenic patients, especially if other agents are unsuitable.
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Antimicrob Agents Chemother
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Bucaneve, G.7
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Cometta A, Viscoli C, Castagnola E, Massimo L, Giacchino R, Gibson B, Balbo L, Engelhard D, Shapiro M, Amsallem D et al.: Empirical treatment of fever in neutropenic children: the role of the carbapenems. Pediatr Infect Dis J 1996, 15:744-748.
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A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic patients
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Raad II, Whimbey EE, Rolston KV, Abi-Said D, Hachem RY, Pandya RG, Ghaddar HM, Karl CL, Bodey GP: A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic patients. Cancer 1996, 77:1386-1394.
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Raad, I.I.1
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25
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0030057185
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Early identification of neutropenic patients at risk of Gram-positive bacteraemia and the impact of empirical administration of vancomycin
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Dompeling EC, Donnelly JP, Deresinski SC, Feld R, Lane-Allman EF, De Pauw BE: Early identification of neutropenic patients at risk of Gram-positive bacteraemia and the impact of empirical administration of vancomycin. Eur J Cancer 1996, 32A:1332-1339. A randomized study showed that vancomycin need not be included in the primary treatment regimen even if there was clinically evident skin and soft tissue infection. Although vancomycin eradicated Gram-positive bacteria better than ceftazidime or piperacillin-gentamicin, it did not improve the clinical outcome and there was some toxicity.
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0030600064
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De Pauw BE, Dompeling EC: Antibiotic strategy after the empiric phase in patients treated for a haematological malignancy. Ann Hematol 1996, 72:273-279. This study analysed 1951 febrile neutropenic episodes and showed that unnecessary additions or changes to therapy were often made. Twenty-five per cent of changes were associated with objective reasons at night compared with 93% during the day. Empirical change was, however, indicated when new specific localizing signs were noted, and in such cases modification was often reasonable.
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Ann Hematol
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Anaissie, E.J.1
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Rex JH, Pfaller MA, Galgiani JN, Bartlett MS, Espinel-Ingroff AE, Ghannoum MA, Lancaster M, Odds FC, Rinaldi MG, Walsh TJ, Barry AL for the Subcommittee on Antifungal Susceptibility Testing of the National Committee of Clinical Laboratory Standards: Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole and candida infections. Clin Infect Dis 1997, 24:235-247.
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EORTC Protocol 19923 [Abstract LM39]. New Orleans
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Ellis M, Spence D, Meunier F, De Pauw B, Bogaerts M, Van Der Cam B, Doyen C, Marinus A, Collette L, Sylvester R: Randomized multicentre trial of 1 mg/kg versus 4 mg/kg liposomal amphotericin B (Ambisome) in the treatment of invasive aspergillosis. EORTC Protocol 19923 [Abstract LM39]. 36th Interscience Conference on Antimicrobial Agents and Chemotherapy. New Orleans; 1996.
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