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Invasive fungal disease in adults undergoing remission-induction therapy for acute myeloid leukemia: the pathogenetic role of the antileukemic regimen. Clin Infect Dis
, 1995
"... Using multivariate techniques, we studied the relationships of cytotoxic regimen, intestinal muco-sal damage, and fungal colonization in the pathogenesis of invasive fungal disease in 138 patients undergoing induction therapy for untreated acute myeloid leukemia (AML) according to three institutiona ..."
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Using multivariate techniques, we studied the relationships of cytotoxic regimen, intestinal muco-sal damage, and fungal colonization in the pathogenesis of invasive fungal disease in 138 patients undergoing induction therapy for untreated acute myeloid leukemia (AML) according to three institutional protocols: AML-84 (cytarabine/daunorubicin), AML-87 (high-dose cytarabine/etopo-side/daunorubicin), and AML-88(mitoxantrone/etoposide). Invasive fungal disease occurred in 36%,
Infection and Mucosal Injury in Cancer Treatment
"... The oral and gastrointestinal mucosa acts as an important mechanical barrier that prevents local or systemic invasion by microorganisms. Cytotoxic chemotherapy-induced muco-sal injury (MI) of oral cavity and intestinal epithelium oc-curs in many patients treated for malignancy. Compromise of the muc ..."
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The oral and gastrointestinal mucosa acts as an important mechanical barrier that prevents local or systemic invasion by microorganisms. Cytotoxic chemotherapy-induced muco-sal injury (MI) of oral cavity and intestinal epithelium oc-curs in many patients treated for malignancy. Compromise of the mucosal barrier can contribute to local invasion by colonizing microorganisms and, subsequently, to systemic infection. Historically, gram-negative bacteremia has been the most problematic bacterial infection in neutropenic pa-tients, but its incidence has reduced over time because of the use of prophylactic antibiotics. There has been a shift in the type of infecting organisms responsible for bacteremia in these patients, from predominantly gram-negative organ-isms to gram-positive cocci. The viridans group of strepto-cocci is composed of the most frequent bacterial pathogens
Predictors of viridans streptococcal shock syndrome in bacteremic children with cancer and stem-cell transplant recipients. J.Clin. Oncol
, 2004
"... To describe episodes of viridans streptococcal bacteremia (VSB) in a cohort of children with cancer and stem-cell transplant (SCT) recipients and to determine predictors of viridans streptococcal shock syndrome (VSSS) in this group of children. Patients and Methods For this retrospective review, we ..."
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To describe episodes of viridans streptococcal bacteremia (VSB) in a cohort of children with cancer and stem-cell transplant (SCT) recipients and to determine predictors of viridans streptococcal shock syndrome (VSSS) in this group of children. Patients and Methods For this retrospective review, we included episodes of VSB isolated between March 1997 and September 2002, in children ( 18 years) with a diagnosis of cancer or SCT patients. The primary outcome was VSSS, defined as hypotension requiring intravascular volume expansion or inotropic support and/or respiratory insufficiency necessitating assisted ventilation. Results Eighty-eight episodes of VSB occurred in 79 children. The mean age of the children was 6.7 years (range, 0.6 to 18.0 years). The most common underlying diagnosis was acute myelogenous leukemia (AML) in
Viral abrogation of stem cell transplantation tolerance causes graft rejection and host death by different mechanisms
, 2002
"... Program in Immunology and Virology COPYRIGHT INFORMATION The chapters of this dissertation have appeared in the following publication: ..."
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Program in Immunology and Virology COPYRIGHT INFORMATION The chapters of this dissertation have appeared in the following publication:
Villejuif; the Service des Maladies du Sang, Centre Hospitalo-
"... We conducted a randomized multicenter study to compare the efficacy and safety of two antibiotic regimens (cefepime [2 g bid.] plus amikacin or ceftazidime [2 g t.i.d.] plus amikacin) as first-line therapy for fever in patients with hematologic malignancies and neutropenia. A total of 353 patients w ..."
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We conducted a randomized multicenter study to compare the efficacy and safety of two antibiotic regimens (cefepime [2 g bid.] plus amikacin or ceftazidime [2 g t.i.d.] plus amikacin) as first-line therapy for fever in patients with hematologic malignancies and neutropenia. A total of 353 patients were randomized according to a 2:1 (cefepime:ceftazidime) ratio. Two hundred-twelve patients in the cefepime group and 107 in the ceftazidime group (90 % of all patients) were evaluable for efficacy. The polymorphonuclear neutrophil count was <100/mm3 on enrollment for 70 % of the patients. The mean duration of neutropenia was 26 days. The efficacy in both study arms was comparable, although a trend in favor of cefepime was seen in terms of therapeutic success (response rate, 27 % vs. 21 % for the ceftazidime group). The overall response rate after glycopeptides were added to the regimens was 60 % for the cefepime group and 51% for the ceftazidime group; the bacterial eradication rates were 81 % vs. 76%, respectively, and the rates of new bacterial infections were 14 % vs. 18%, respectively. We conclude that the combination cefepime/ amikacin is at least as effective as the reference regimen of ceftazidime/amikacin in this setting. For at least 25 years, the use of a combination of antibiotics has been the cornerstone of therapy for febrile patients with cancer and severe treatment-induced neutropenia [1, 2]. The
Impact of Fluoroquinolone Prophylaxis on Reduced Infection-Related Mortality among Patients with
"... (See the editorial commentary by Zinner on pages 1094–5) Background. Fluoroquinolone prophylaxis during neutropenia in patients with cancer has been associated with decreased incidence of gram-negative bacteremia. Bacterial antimicrobial resistance is likely to cause a pro-gressive lack of efficacy ..."
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(See the editorial commentary by Zinner on pages 1094–5) Background. Fluoroquinolone prophylaxis during neutropenia in patients with cancer has been associated with decreased incidence of gram-negative bacteremia. Bacterial antimicrobial resistance is likely to cause a pro-gressive lack of efficacy of fluoroquinolones, but no convincing evidence from clinicoepidemiologic observations has proved this hypothesis. Methods. This prospective observational study assessed the impact of discontinuing fluoroquinolone pro-phylaxis on the incidences of fever and bacteremia and on mortality among patients with neutropenia, after chemotherapy for hematologic malignancies. Results. After a 12-month baseline period of levofloxacin prophylaxis, a period of discontinuation of fluor-oquinolone prophylaxis was planned but was stopped prematurely after 9 neutropenic episodes over 3 weeks, because the mortality rate (33.3%) was higher than that with routine fluoroquinolone prophylaxis (2.9%) (odds ratio [OR], 16.6; 95 % confidence interval [CI], 3.6–77.2). Fewer patients had gram-negative bacteremia during the baseline period (4.8%; ) than during the discontinuation period (44.4%; ) (OR, 16.9; 95 % CI,np 15 np 4 4.1–70.0). After levofloxacin therapy was reintroduced, the incidence of gram-negative bacteremia and the mortality rate were comparable to those during the first period. Escherichia coli isolated during the discontinuation period
Parallel Evolution of Streptococcus pneumoniae and Streptococcus mitis to Pathogenic and Mutualistic Lifestyles
"... ABSTRACT The bacterium Streptococcus pneumoniae is one of the leading causes of fatal infections affecting humans. Intrigu-ingly, phylogenetic analysis shows that the species constitutes one evolutionary lineage in a cluster of the otherwise commensal Streptococcus mitis strains, with which humans l ..."
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ABSTRACT The bacterium Streptococcus pneumoniae is one of the leading causes of fatal infections affecting humans. Intrigu-ingly, phylogenetic analysis shows that the species constitutes one evolutionary lineage in a cluster of the otherwise commensal Streptococcus mitis strains, with which humans live in harmony. In a comparative analysis of 35 genomes, including phyloge-netic analyses of all predicted genes, we have shown that the pathogenic pneumococcus has evolved into a master of genomic flexibility while lineages that evolved into the nonpathogenic S. mitis secured harmonious coexistence with their host by stabi-lizing an approximately 15%-reduced genome devoid of many virulence genes. Our data further provide evidence that interspe-cies gene transfer between S. pneumoniae and S. mitis occurs in a unidirectional manner, i.e., from S. mitis to S. pneumoniae. Import of genes from S. mitis and other mitis, anginosus, and salivarius group streptococci ensured allelic replacements and antigenic diversification and has been driving the evolution of the remarkable structural diversity of capsular polysaccharides of S. pneumoniae. Our study explains how the unique structural diversity of the pneumococcal capsule emerged and conceivably will continue to increase and reveals a striking example of the fragile border between the commensal and pathogenic lifestyles. While genomic plasticity enabling quick adaptation to environmental stress is a necessity for the pathogenic streptococci, the commensal lifestyle benefits from stability. IMPORTANCE One of the leading causes of fatal infections affecting humans, Streptococcus pneumoniae, and the commensal Streptococcus mitis are closely related obligate symbionts associated with hominids. Faced with a shortage of accessible hosts,
Evolution, Incidence, and Susceptibility of Bacterial Bloodstream Isolates from
"... Bacteria remain an important cause of infection in bone marrow transplants. To examine shifts in the etiology and susceptibility of bacterial isolates from transplants, we reviewed the incidence and susceptibility of blood isolates during a 7-year period. The infection rate fell dramatically during ..."
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Bacteria remain an important cause of infection in bone marrow transplants. To examine shifts in the etiology and susceptibility of bacterial isolates from transplants, we reviewed the incidence and susceptibility of blood isolates during a 7-year period. The infection rate fell dramatically during this time. Gram-positive organisms were isolated more often than gram-negative organisms, but the trend is reversing. Streptococci surpassed staphylococci for 5 years as the leading pathogen. Increasing resistance to penicillin, ciprofloxacin, and imi-penem was noted in Streptococcus species. With the exception of type 1 b-lactamase–producing bacteria and Pseudomonas aeruginosa, gram-negative isolates remained overall susceptible to ceftazidime. Increased anti-biotic prophylaxis coincided with the reduction in percentage of infected patients and increase in resistance to b-lactam antibiotics. Mortality attributed to bacteremia was low except for infections caused by P. aeruginosa and the Enterobacter, Serratia, Citrobacter group. There was no mortality attributable to gram-positive or-ganisms such as Staphylococcus aureus and viridans streptococci. Infection remains an important cause of morbidity and mortality in febrile neutropenia [1]. Bacteremia is the estimated cause of fever in 25 % of all neutropenic pa-tients [2] and fungemia or localized fungal infections,
panel for Antimicrobial Susceptibility Testing of α-hemolytic streptococci Isolated from Patients
"... Abstract The purpose of this study was availability for the classical test method. The test were called CLSI(Clinical and Laboratory Standards Institute) that was disk diffusion method, the newly designed E-test(made use disk diffusion method) can estimate the MIC and modified broth microdilution me ..."
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Abstract The purpose of this study was availability for the classical test method. The test were called CLSI(Clinical and Laboratory Standards Institute) that was disk diffusion method, the newly designed E-test(made use disk diffusion method) can estimate the MIC and modified broth microdilution method that was standardized. Those tests were observed by MicroScan MicroSTREP plus panel. Target strains were 53 strains of S.pneumoniae and 51 strains of α-hemolytic streptococci which were separated from the inpatient in university hospital for 6 months from February to August, 2009. The 9 antimicrobial agent of target evaluation were cefotaxime, chloramphenicol, clindamycin, erythromycin, levofloxacin, penicillin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin. researched comparative analysis both S.pneumoniae and α-hemolytic streptococci. The result of the high concordance rates in α-hemolytic streptococci was recognized formally in clinical microbiology laboratory.
Larry J. Strausbaugh, Section Editor Infections Caused by Viridans Streptococci in Patients with
"... The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10–15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabino ..."
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The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10–15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock–like syndrome has been described; Streptococcus mitis has been the causative species in most cases. Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome. Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of anti-microbial prophylaxis for neutropenic patients with cancer should be reconsidered. Over the course of the last several decades, the frequency with which gram-positive bacteria have been isolated from neutro-penic patients with cancer has increased. Data from the Inter-national Antimicrobial Therapy Cooperative Group of the Eu-ropean Organization for Research and Treatment of Cancer
