RESUMO
In a study undertaken to evaluate fluoroquinolone prophylaxis in afebrile granulocytopenic patients, an unexpected association between chemotherapy schedule and a later development of bacteremia--during the subsequent febrile neutropenic episodes--was found. Twenty five febrile neutropenic episodes consecutive to chemotherapy for acute leukemia were studied. Patients received either etoposide and mitoxantrone or citarabine--in standard, intermediate or high doses--combined with daunomicin or mitoxantrone. Microbiologic data analysis showed an increased incidence of bacteremia with combined anthracycline and intermediate or high dose citarabine administration, when compared to etoposide and mitoxantrone use (p = 0.000387). Both groups developed similarly fast and severe neutropenias and equivalent grades of digestive mucositis. Chemotherapy schedule was the only factor associated with a consecutive bacteremia--or not--during the subsequent neutropenic episode. We conclude that effects other than bone marrow aplasia and digestive mucositis may be relevant in infectious susceptibility induced by cytostatic drugs.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bacteriemia/prevenção & controle , Daunorrubicina/uso terapêutico , Leucemia/tratamento farmacológico , Neutropenia/induzido quimicamente , Doença Aguda , Adolescente , Adulto , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Bacteriemia/etiologia , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Quimioterapia Combinada , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Humanos , Masculino , Mitoxantrona/administração & dosagem , Mitoxantrona/efeitos adversos , Neutropenia/complicações , Neutropenia/tratamento farmacológico , Fatores de RiscoRESUMO
Characteristics of afebrile infection episodes among adult patients with acute leukemia are here described. Afebrile episodes represented 14.3% of all infections. They significantly differed from the febrile episodes because: 1) they prevailed among patients with granulocyte count greater than 500/mm3 (p < 0.001); 2) they often involved patients in complete remission (p < 0.0002); 3) they affected more frequently the kidney and urinary tract than febrile infections (p = 0.0005) and 4) they lacked lung involvement (p < 0.01). The rate of documented infections by cultures, cytology or serological tests was not different between both infection types. Observed mortality during afebrile episodes was threefold less than febrile infections; this difference, however, did not reach statistical significance. In conclusion, afebrile infection in acute leukemia is a distinct clinical entity, unlike febrile infection.
Assuntos
Leucemia/complicações , Infecções Urinárias/complicações , Adolescente , Adulto , Idoso , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Estudos Prospectivos , Infecções Urinárias/diagnósticoRESUMO
Characteristics of afebrile infection episodes among adult patients with acute leukemia are here described. Afebrile episodes represented 14.3
of all infections. They significantly differed from the febrile episodes because: 1) they prevailed among patients with granulocyte count greater than 500/mm3 (p < 0.001); 2) they often involved patients in complete remission (p < 0.0002); 3) they affected more frequently the kidney and urinary tract than febrile infections (p = 0.0005) and 4) they lacked lung involvement (p < 0.01). The rate of documented infections by cultures, cytology or serological tests was not different between both infection types. Observed mortality during afebrile episodes was threefold less than febrile infections; this difference, however, did not reach statistical significance. In conclusion, afebrile infection in acute leukemia is a distinct clinical entity, unlike febrile infection.
RESUMO
In order to evaluate whether the prophylactic use of fluoroquinolones diminishes the incidence of infections and/or mortality during neutropenia, we undertook a prospective, aleatory and controlled study in non-hospitalized adult patients with acute leukemia and chemotherapy-induced neutropenia including twenty five episodes of neutropenia including twenty five episodes of neutropenia which had occurred in 14 patients who were randomly selected either to receive or not quinolones (norfloxacin 800 mg daily or ciprofloxacin 1000 mg daily). Both groups were similar in terms of sex, age, underlying disease, chemotherapy for hematologic malignancy, duration and severity of neutropenia. The use of quinolones was associated with a delay in the fever onset during neutropenia (p = 0.0448), a decrease in the proportion of neutropenic febrile days (p = 0.0456), a decrease of infections caused by gram-negative bacilli (p = 0.037) and an increase of Streptococcus infections (p = 0.0857). There was no significant decrease in mortality, incidence of severe infections, proportion of neutropenic episodes without fever, empiric use of amphotericin B or fungal infections between both groups. The results of this study demonstrate that the prophylactic use of fluoroquinolones does not diminish the infectious morbidity and/or mortality in these patients.
Assuntos
Anti-Infecciosos/uso terapêutico , Neutropenia/complicações , Doença Aguda , Adolescente , Adulto , Infecções Bacterianas/prevenção & controle , Feminino , Febre/prevenção & controle , Fluoroquinolonas , Humanos , Leucemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
In order to evaluate whether the prophylactic use of fluoroquinolones diminishes the incidence of infections and/or mortality during neutropenia, we undertook a prospective, aleatory and controlled study in non-hospitalized adult patients with acute leukemia and chemotherapy-induced neutropenia including twenty five episodes of neutropenia including twenty five episodes of neutropenia which had occurred in 14 patients who were randomly selected either to receive or not quinolones (norfloxacin 800 mg daily or ciprofloxacin 1000 mg daily). Both groups were similar in terms of sex, age, underlying disease, chemotherapy for hematologic malignancy, duration and severity of neutropenia. The use of quinolones was associated with a delay in the fever onset during neutropenia (p = 0.0448), a decrease in the proportion of neutropenic febrile days (p = 0.0456), a decrease of infections caused by gram-negative bacilli (p = 0.037) and an increase of Streptococcus infections (p = 0.0857). There was no significant decrease in mortality, incidence of severe infections, proportion of neutropenic episodes without fever, empiric use of amphotericin B or fungal infections between both groups. The results of this study demonstrate that the prophylactic use of fluoroquinolones does not diminish the infectious morbidity and/or mortality in these patients.