RESUMEN

Early antibiotic discontinuation has been proposed in patients with hematologic malignancy with fever of unknown origin during febrile neutropenia (FN). We intended to investigate the safety of early antibiotic discontinuation in FN. Two reviewers independently searched for articles from Embase, CENTRAL, and MEDLINE on 30 September 2022. The selection criteria were randomized control trials (RCTs) comparing short- and long-term durations for FN in cancer patients, and evaluating mortality, clinical failure, and bacteremia. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. We identified eleven RCTs (comprising 1128 distinct patients with FN) from 1977 to 2022. A low certainty of evidence was observed, and no significant differences in mortality (RR 1.43, 95% CI, 0.81, 2.53, I2 = 0), clinical failure (RR 1.14, 95% CI, 0.86, 1.49, I2 = 25), or bacteremia (RR 1.32, 95% CI, 0.87, 2.01, I2 = 34) were identified, indicating that the efficacy of short-term treatment may not differ statistically from that of long-term treatment. Regarding patients with FN, our findings provide weak conclusions regarding the safety and efficacy of antimicrobial discontinuation prior to neutropenia resolution.

RESUMEN

OBJECTIVE: To determine the time to normalization of procalcitonin (PCT) levels and duration of antibiotics in neonatal sepsis. METHODS: A prospective observational study design was used. The participants included were neonates with sepsis. The primary outcome measure was time to normalization of PCT levels and duration of antibiotics following clinical resolution. RESULTS: Time to normalization of PCT levels was 9.6 ± 4.2 days in neonates with septic shock, 6.2 ± 2.5 days in neonates without shock, 9.6 ± 3.1 days in neonates with culture-positive sepsis and 6.4 ± 3.1 days in neonates with culture-negative sepsis. Time to normalization of PCT levels according to the stage of systemic inflammatory response syndrome was 5.8 ± 2.8 days in neonates with sepsis, 6.1 ± 3.1 days in those with sepsis syndrome, 6.3 ± 3.3 days in those with early septic shock and 9.4 ± 3.6 days in those with multiorgan dysfunction syndrome. There was no morbidity and mortality in any neonate in the 4-week follow-up. CONCLUSION: The duration of antibiotics can be determined by observing the time to normalization of PCT following clinical resolution of sepsis.

Asunto(s)

RESUMEN

Objectives: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. Methods: Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. Results: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×10(9)/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. Conclusion: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.

Asunto(s)

RESUMEN

OBJECTIVE: To compare the effect of 4 day course (study group) with 7 day course (control group) of antibiotic treatment in neonatal pneumonia, on treatment success rate. METHODS: This randomized controlled trial was conducted in a tertiary teaching hospital. Seventy, term and near-term neonates with pneumonia who had clinical remission by 48 h of antibiotic therapy were included. The neonates were randomized to receive a total of 4 d of antibiotics (Group 1) or 7 d of antibiotics (Group 2). The outcome measure was treatment failure in each group within 3 d of discharge. RESULTS: The treatment success rate of both the groups was 100%. There was a significant reduction in the duration of hospital stay (p < 0.001), antibiotic usage (p < 0.001), and cost (p < 0.001) in the 4 d group. On follow up till 28 d of enrollment, no infective morbidity was found in either group. CONCLUSIONS: For term and near-term neonates who become clinically asymptomatic within 48 h of antibiotic therapy, 4 d of antibiotic therapy is as effective and safe as 7 d of antibiotic therapy, with significant reduction in hospital stay, antibiotic usage and cost.

Asunto(s)

RESUMEN

Objectives: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. Methods: Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. Results: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×10(9)/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. Conclusion: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.

Asunto(s)

RESUMEN

Objectives@#To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. @*Methods@#Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. @*Results@#A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×109/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. @*Conclusion@#Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.

RESUMEN

OBJECTIVE: To study the effect of chlorhexidine (CHD) application on umbilical cord and evaluate its impact on duration of NICU stay and antibiotic exposure days. METHOD: We enrolled 140 newborns in our study (70 in intervention group and 70 in control group), and their data were collected. Newborns in control group were given routine umbilical cord care, and intervention group received CHD spray on umbilical cord three times a day and for the next three days of cord fall. In this study, swabs were sent from umbilical cord at the age of three and seven days of life for culture. Data regarding culture-proven sepsis, duration of NICU stay and antibiotic days were recorded in the proforma for data collection. RESULTS: This is a secondary analysis of the data of the randomized control trial. A significant reduction in duration of nursery stay was seen in CHD group in comparison with control group (12.4 ± 5.38 d versus 14.7 ± 6.62 d, p = 0.04, significant). Significant reduction was also seen in days of antibiotic exposure in the intervention group (9.74 ± 6.88 d versus 12.1 ± 7.78 d, p = 0.04, significant). CONCLUSION: Application of CHD to umbilical cord shortens duration of nursery stay and antibiotic days during nursery admission. This simple intervention may be used as mode in places where nursery facilities are limited, as aid in early discharge and shortening the exposure to antibiotic, which may help in reducing the prevalence of multidrug-resistance microbes. This cheap intervention may also be effective in reducing the economical burden on the health infrastructure of the country and parents.

Asunto(s)

RESUMEN

OBJECTIVES: To compare the effect of 10 days versus 14 days of antibiotic therapy in neonatal meningitis on treatment failure rate. METHODS: The study was a randomized controlled trial conducted at a referral neonatal unit. The participants were 70 neonates with meningitis randomized to receive 10 days (study group) or 14 days (control group) of antibiotics. The primary outcome measure studied was treatment failure in each group within 28 days of enrolment. RESULTS: None of the neonates among either of the groups had occurrence of meningitis during follow-up. Occurrence of sepsis was observed after discharge in three neonates in the control group and none in the study group. Brainstem-evoked response audiometry was abnormal in one neonate in the study group. Adverse effects of drugs and neurological deficits were not observed in the study population. CONCLUSIONS: Short course of antibiotic therapy (10 days) is effective, with potential benefits of shorter hospital stay.

Asunto(s)

RESUMEN

BACKGROUND AND OBJECTIVE: Chorioamnionitis (CAM) is a major risk factor for neonatal sepsis. At our institution, neonates exposed to CAM and intrapartum antibiotics are treated with prolonged antimicrobial therapy if laboratory values are abnormal despite a sterile blood culture. Recently, the Committee on the Fetus and Newborn (COFN) recommended a similar strategy for treating neonates exposed to CAM. Our objective was to determine the frequency of abnormal laboratory parameters in term and late-preterm neonates exposed to CAM and evaluate the implication of recent COFN guidelines. METHODS: This retrospective data analysis included late-preterm and term neonates exposed to CAM. Laboratory parameters, clinical symptoms and the number of infants treated with prolonged antibiotics were determined. RESULTS: A total of 554 infants met the inclusion criteria. Eighty-three infants (14.9%) had an abnormal immature to total neutrophil ratio (>0.2) and 121 infants (22%) had an abnormal C-reactive protein level (>1 mg/dL) at 12 hours of age. A total of 153 infants (27.6%) had an abnormal immature to total neutrophil ratio and/or abnormal C-reactive protein level at 12 hours of age. Only 4 (0.7%) of 554 infants had a positive blood culture result. A total of 134 (24.2%) infants were treated with prolonged antibiotics (112 [20.2%] were treated solely based on abnormal laboratory data). Lumbar puncture was performed in 120 (21.6%) infants. CONCLUSIONS: When managed by using a strategy similar to recent COFN guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy due to abnormal laboratory findings. They were also subjected to additional invasive procedures and had a longer duration of hospitalization.

Asunto(s)