Abstract
This study aimed to evaluate the efficacy of amikacine and ceftazidime as an empirical antibiotic therapy for neutropenic patients affected by haematological neoplasms and to investigate the presence of prognostic features suggesting a poor outcome with this antibiotic combination at the onset of infection. This could allow the identification of subgroups of patients with a low rate of response to amikacin/ceftazidime therapy; in these patients different initial empirical therapy may be indicated. The study population comprised 166 severely neutropenic (absolute neutrophil count below 500/μl) oncohaematological patients with fever or clinical signs of infection. Multivariate analysis confirmed four negative prognostic factors: 3 or more days of hospitalization at the onset of an infectious episode, a diagnosis of acute myeloid leukaemia, a haematological disease status different from complete remission, the presence of pneumonia. Depending on how many factors are present, cases can be stratified into three groups, of significantly different prognosis: favourable (0 or 1 factor) 76% success; intermediate (2 factors) 52% success; unfavourable (3 or 4 factors) 19% success. At the onset of an infectious episode a subgroup of patients with a very low response rate to empirical amikacin/ceftazidime antibiotic therapy is identifiable, for whom a different therapy is indicated. Because of the high rate of proven or probable fungal infections in this group, the immediate administration of a systemic antifungal therapy, in addition to antibacterial agents, could be considered in these high-risk patients. Studies should be specifically addressed to evaluating a stratification of empirical antibiotic therapy according to risk factors present at the onset of infection.
| Original language | English |
|---|---|
| Pages (from-to) | 259-265 |
| Number of pages | 7 |
| Journal | Supportive Care in Cancer |
| Volume | 2 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Jul 1994 |
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Keywords
- β-Lactamic-aminoglycoside combinations
- Febrile neutropenic cancer patients
- Infection
ASJC Scopus subject areas
- Nursing(all)
- Oncology
Cite this
Amikacin and ceftazidime as empirical antibiotic therapy in severely neutropenic patients : analysis of prognostic factors. / Rossini, Fausto; Pioltelli, Pietro; Mingozzi, Silvia; Bregani, Rino; Viganó, Franco; Bolis, Silvia; Casaroli, Ivana; Lanzi, Eraldo; Pogliani, Enrico M.; Corneo, Gianmarco.
In: Supportive Care in Cancer, Vol. 2, No. 4, 07.1994, p. 259-265.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Amikacin and ceftazidime as empirical antibiotic therapy in severely neutropenic patients
T2 - analysis of prognostic factors
AU - Rossini, Fausto
AU - Pioltelli, Pietro
AU - Mingozzi, Silvia
AU - Bregani, Rino
AU - Viganó, Franco
AU - Bolis, Silvia
AU - Casaroli, Ivana
AU - Lanzi, Eraldo
AU - Pogliani, Enrico M.
AU - Corneo, Gianmarco
PY - 1994/7
Y1 - 1994/7
N2 - This study aimed to evaluate the efficacy of amikacine and ceftazidime as an empirical antibiotic therapy for neutropenic patients affected by haematological neoplasms and to investigate the presence of prognostic features suggesting a poor outcome with this antibiotic combination at the onset of infection. This could allow the identification of subgroups of patients with a low rate of response to amikacin/ceftazidime therapy; in these patients different initial empirical therapy may be indicated. The study population comprised 166 severely neutropenic (absolute neutrophil count below 500/μl) oncohaematological patients with fever or clinical signs of infection. Multivariate analysis confirmed four negative prognostic factors: 3 or more days of hospitalization at the onset of an infectious episode, a diagnosis of acute myeloid leukaemia, a haematological disease status different from complete remission, the presence of pneumonia. Depending on how many factors are present, cases can be stratified into three groups, of significantly different prognosis: favourable (0 or 1 factor) 76% success; intermediate (2 factors) 52% success; unfavourable (3 or 4 factors) 19% success. At the onset of an infectious episode a subgroup of patients with a very low response rate to empirical amikacin/ceftazidime antibiotic therapy is identifiable, for whom a different therapy is indicated. Because of the high rate of proven or probable fungal infections in this group, the immediate administration of a systemic antifungal therapy, in addition to antibacterial agents, could be considered in these high-risk patients. Studies should be specifically addressed to evaluating a stratification of empirical antibiotic therapy according to risk factors present at the onset of infection.
AB - This study aimed to evaluate the efficacy of amikacine and ceftazidime as an empirical antibiotic therapy for neutropenic patients affected by haematological neoplasms and to investigate the presence of prognostic features suggesting a poor outcome with this antibiotic combination at the onset of infection. This could allow the identification of subgroups of patients with a low rate of response to amikacin/ceftazidime therapy; in these patients different initial empirical therapy may be indicated. The study population comprised 166 severely neutropenic (absolute neutrophil count below 500/μl) oncohaematological patients with fever or clinical signs of infection. Multivariate analysis confirmed four negative prognostic factors: 3 or more days of hospitalization at the onset of an infectious episode, a diagnosis of acute myeloid leukaemia, a haematological disease status different from complete remission, the presence of pneumonia. Depending on how many factors are present, cases can be stratified into three groups, of significantly different prognosis: favourable (0 or 1 factor) 76% success; intermediate (2 factors) 52% success; unfavourable (3 or 4 factors) 19% success. At the onset of an infectious episode a subgroup of patients with a very low response rate to empirical amikacin/ceftazidime antibiotic therapy is identifiable, for whom a different therapy is indicated. Because of the high rate of proven or probable fungal infections in this group, the immediate administration of a systemic antifungal therapy, in addition to antibacterial agents, could be considered in these high-risk patients. Studies should be specifically addressed to evaluating a stratification of empirical antibiotic therapy according to risk factors present at the onset of infection.
KW - β-Lactamic-aminoglycoside combinations
KW - Febrile neutropenic cancer patients
KW - Infection
UR - http://www.scopus.com/inward/record.url?scp=0028473617&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0028473617&partnerID=8YFLogxK
U2 - 10.1007/BF00365733
DO - 10.1007/BF00365733
M3 - Article
C2 - 8087446
AN - SCOPUS:0028473617
VL - 2
SP - 259
EP - 265
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
SN - 0941-4355
IS - 4
ER -