RESUMEN

In a regional oncology hospital using cotrimoxazole (trimethoprim-sulphamethoxazole) prophylaxis during chemotherapy-induced neutropenia, a single strain of Escherichia coli (indole negative) caused 15 of 27 episodes of Gram-negative rod bacteremia in 1987, and four of 32 such episodes in 1988. This biotype had not been recovered in 1986. Investigations during this 'outbreak' of bacteremias revealed enteric colonization with this strain of E coli in 37% of patients on leukemia or bone marrow transplant wards and in several staff members in July 1987. In 1988, 11 of 32 Gram-negative rod bacteremias were secondary to other strains of indole positive E coli of several different biotypes and plasmid profiles. Indole negative strains all exhibited low level trimethoprim resistance, whereas indole positive strains which subsequently appeared exhibited high level trimethoprim resistance. Failure of cotrimoxazole prophylaxis was initially due to the clonal dissemination of a single strain of E coli within the institution, with the subsequent appearance of multiple E coli strains with probable differing genetic bases for their resistance.

RESUMEN

The complications associated with the use of Ommaya reservoirs in 106 patients with meningeal involvement due to malignant disease are reviewed. Twenty-seven patients had acute lymphoblastic leukemia, 12 acute myelogenous leukemia, 3 chronic lymphocytic leukemia, 34 lymphoma, 29 carcinoma, and 1 chronic myelocytic leukemia. There were 11 technical complications, including 1 death due to misplacement of the catheter, 2 mild intraventricular hemorrhages, and 5 malfunctioning reservoirs; 3 required craniotomies (1 for subdural hematoma and 2 for subdural hygroma); 13 cases of bacterial meningitis occurred in 10 patients. One patient died of Staphylococcus aureus meningitis. The organisms causing the other infections were mainly coagulase-negative staphylococci (8 cases) or Propionibacterium acnes (2 cases). The projected infection rate for all patients (by Kaplan-Meier analysis) during the first year following insertion of a reservoir was 15%. Successful use of Ommaya reservoirs requires expert surgical implantation and meticulous care during accessing to minimize complications.

Asunto(s)

RESUMEN

The sensitivity of the Salmonella reversion test of Ames as a screen for accidental absorption of 17 antineoplastic agents by drug handlers was evaluated. Dilutions of each drug were added to agar inoculated with each of two Salmonella typhimurium strains (TA98 and TA100); control plates contained no test drug. Colonies were counted after incubation at 36 degrees C for 48 hours. The drugs were tested in the presence of a liver preparation to provide metabolic activation of mutagenicity. Urine samples collected from patients after doses of three mutagenic drugs were extracted and tested with the Ames test. For 11 of the 17 drug solutions, no mutagenic activity was seen, but many of these 11 were toxic to the organisms. The most highly mutagenic drugs were doxorubicin and cisplatin, with mechlorethamine, carmustine, dacarbazine, and cyclophosphamide exhibiting less mutagenic activity. Urine from patients treated with doxorubicin or cyclophosphamide showed mutagenicity, but the results suggested that the quantity of these drugs that would have to be absorbed to produce a definite reaction in urine is unlikely to be achieved by drug handlers who use standard precautions. Because of its lack of sensitivity and the potential effects of environmental and dietary factors on the results, this bacterial mutagenicity test should not be used routinely for detection of accidental absorption of antineoplastic drugs.

Asunto(s)

RESUMEN

A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature greater than 38.5 degrees C) episodes in 64 (neutrophils, less than 1,000/microL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia.

Asunto(s)

RESUMEN

Invasive fungal disease continues to be a significant problem among immunocompromised patients. We report a case of systemic Rhodotorula infection in a patient with acute myelogenous leukaemia. Rhodotorula was isolated from bone marrow on two separate occasions despite initial treatment with amphotericin B. Liver computerised tomographic scan suggested liver abscesses, and yeasts were seen on biopsy. The patient survived after aggressive antifungal and antileukaemia treatment. Rhodotorula fungaemia has been occasionally associated with shock. As our case illustrates, Rhodoturola may be a cause of invasive fungal disease in the immunocompromised host but can be eradicated if treated aggressively.

Asunto(s)

RESUMEN

A combination of amikacin sulfate given by continuous infusion (800 mg/sq m/24 hr) plus cephalothin sodium (2 g every four hours) was used as initial empiric therapy for the treatment of 65 evaluable febrile (greater than 38.5 degrees C) episodes in 54 granulcoytopenic (neutrophils, less than 1,000/microliter) adult cancer patients. Carbenicillin disodium (5 g every four hours) was substituted for cephalothin in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Thirty-two of the 38(84%) identifiable infections responded to therapy, including all of the eight septicemias and eight of 11 pneumonias. Three additional infections responded to the substitution of carbenicillin for cephalothin, for a total response rate of 92% (35/38). Nephrotoxicity occurred in five patients (7.1%), most commonly in patients over 60 years of age. Ototoxicity, highly correlated with a duration of greater than 19 days and a total dosage of greater than 25 g of amikacin sulfate, occurred in four patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients.

Asunto(s)

RESUMEN

The clinical course of a 69-year-old male with acute myelogenous leukemia is described who, while extremely leukopenic (less than 100 neutrophils/microliter) from chemotherapy, developed a cavitating pneumonia due to a gram-positive coccus, Micrococcus luteus. Aggressive antibiotic management and attainment of complete remission of his leukemia resulted in a successful outcome. A review of the literature regarding the pathogenicity of this organism and, in particular, its occurrence as a cause of pneumonia is presented.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)