Posts filed under ‘Infecciones en onco-hematologicos’

Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update.

J Clin Oncol. 2018 Sep 4:JCO1800374

Taplitz RA, Kennedy EB, Bow EJ, et al.

Purpose

To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.

Methods

ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.

Results

Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.

Recommendations

Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus–seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at http://www.asco.org/supportive-care-guidelines.

FULL TEXT

https://ascopubs.org/doi/full/10.1200/JCO.18.00374

PDF (CLIC en PDF)

 

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March 20, 2019 at 3:44 pm

Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018

Morbidity and Mortality Weekly Report December 21, 2018  V.67 N.50 P.1397–1399

Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018

The only Food and Drug Administration (FDA)–approved stem cell products are derived from umbilical cord blood, and their only approved use is hematopoietic and immunologic reconstitution (1).

On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA–approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12.

Patient isolates of E. cloacae had identical pulsed-field gel electrophoresis patterns, suggesting a common source …

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6750a5-H.pdf

December 26, 2018 at 8:52 am

Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

American Journal of Infection Control November 2018 V.46 N.11 P.1266–1271

Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber on behalf of the Ontario VRE Investigators

Highlights

  • Forty percent of patients with VRE bacteremia died within 30 days.
  • Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the intensive care unit are at highest risk of VRE bacteremia.
  • Larger hospital size and teaching hospitals were independent predictors of VRE bacteremia.

Background

Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.

Methods

All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).

Conclusions

Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/pdf

December 3, 2018 at 7:44 am

Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression – ASCO and IDSA Clinical Practice Guideline Update.

Journal of Clinical Oncology  September 2018

Purpose

To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.

Methods

ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.

Results

Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.

Recommendations

Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus–seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at http://www.asco.org/supportive-care-guidelines.

abstract

http://ascopubs.org/doi/pdf/10.1200/JCO.18.00374

PDF (CLIC en DOWNLOAD)

September 22, 2018 at 4:11 pm

Bloodstream infections in cancer patients. Risk factors associated with mortality

International Journal of Infectious Diseases June 2018 V.71 P.59-64

Beda Islas-Muñoz, Patricia Volkow-Fernández, Cynthia Ibanes-Gutiérrez, Alberto Villamar-Ramírez, Diana Vilar-Compte, Patricia Cornejo-Juárez

Highlights

  • Bloodstream infections (BSI) cause severe complications in cancer patients.
  • Secondary BSI and central-related BSI were the most common in solid tumors.
  • Primary BSI and mucosal barrier injury BSI were described in hematological patients.
  • Mortality at 30-days was increased with multidrug resistant Gram-negative bacteria.
  • Inappropriate antimicrobial treatment in the first 24 h was related with mortality.

Objective

The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR).

Methods

We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI.

Results

4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n = 210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality.

Conclusions

Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30081-X/pdf

July 14, 2018 at 7:25 pm

Pharmacokinetics of anidulafungin in critically ill patients with candidemia/invasive candidiasis.

Antimicrob Agents Chemother. 2013 Apr;57(4):1672-6.

Liu P1, Ruhnke M, Meersseman W, Paiva JA, Kantecki M, Damle B.

Author information

1 Clinical Pharmacology, Specialty Care, Pfizer Inc, Groton, Connecticut, USA.

Abstract

The pharmacokinetics of intravenous anidulafungin in adult intensive care unit (ICU) patients were assessed in this study and compared with historical data from a general patient population and healthy subjects. Intensive plasma sampling was performed over a dosing interval at steady state from 21 ICU patients with candidemia/invasive candidiasis. All patients received the recommended dosing regimen (a 200-mg loading dose on day 1, followed by a daily 100-mg maintenance dose), except for a 54-year-old 240-kg female patient (who received a daily 150-mg maintenance dose instead). Plasma samples were assayed for anidulafungin using a validated liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters in ICU patients were calculated by a noncompartmental method. With the exclusion of the 240-kg patient, the median (minimum, maximum) age, weight, and body mass index (BMI) of 20 ICU patients were 57 (39, 78) years, 65 (48, 106) kg, and 23.3 (16.2, 33.8) kg/m(2), respectively. The average anidulafungin area under the curve over the 24-hour dosing interval (AUC(0-24)), maximum concentration (C(max)), and clearance (CL) in 20 ICU patients were 92.7 mg · h/liter, 7.7 mg/liter, and 1.3 liters/h, respectively. The exposure in the 240-kg patient at a daily 150-mg dose was within the range observed in ICU patients overall. The average AUC(0-24) and Cmax in the general patient population and healthy subjects were 110.3 and 105.9 mg · h/liter and 7.2 and 7.0 mg/liter, respectively. The pharmacokinetics of anidulafungin in ICU patients appeared to be comparable to those in the general patient population and healthy subjects at the same dosing regimen.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623353/pdf/zac1672.pdf

July 7, 2018 at 3:36 pm

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

Clinical Infectious Diseases  March 1, 2009 V.48 N.5 P. 503-35.

Pappas PG1, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD; Infectious Diseases Society of America.

Author information

1 Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. pappas@uab.edu

Abstract

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

abstract

https://academic.oup.com/cid/article/48/5/503/382619

PDF (CLIC en PDF)

July 7, 2018 at 3:34 pm

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