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TAZOBACTAM AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGICAL DISORDERS
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
<7
Class/Days staying I II III IV V
n
%
n
%
n
%
3 3 4 14 6
42,9 60,0 21,1 34,1 33,3
3 0 7 17 1
42,9 0,0 36,8 41,5 8,3
1 2 8 10 7
14,3 40,0 42,1 24,4 58,3
Class/mortalility I II III IV V
>13
8 - 12
NO
YES
n
%
n
%
7 5 19 41 12
100 100 100 97,6 80
0 0 0 1 3
0 0 0 2,4 20
78 years. According to severity of illness 47,7% were grade IV and 21,6% grade III. Median of hospitalization stay was 10 days; in this regard, patients with CAP grade V had the highest hospitalization stay. Global mortality was 4,5% and almost all of deaths were grade V at admission. Chronic kidney disease was the only one comorbidity associated with mortality. The most used antibiotic was levofloxacin. Microbiologic data, antibiotic use and intensive care admission were not associated with mortality. Discussion & conclusion: Majority of patients with CAP who requires hospitalization were grade IV at the moment of admission. Grade V of disease was related with the highest rate of mortality and extended hospitalization. Chronic kidney disease was the only one comorbidity associated with mortality. Keywords: Pneumonia, pneumonia severity index.
and mortality in patients with hematologic malignancies. Empirical broadspectrum antibiotic therapy remains the cornerstone of treatment for febrile neutropenic episodes since bacterial infections are the most common etiologic agents in these episodes. While piperacillin/tazobactam (P/T) monotherapy has been found to be effective in the treatment of neutropenic adult patients, there are no data for cefoperazone/sulbactam (C/S) monotherapy in this population. We evaluated the efficacy of C/S and P/T monotherapy for the empirical treatment of febrile neutropenia in adult patients with hematologic malignancies. Methods: Hospital records of 74 patients were reviewed retrospectively from January 1, 2007 to January 1, 2008 at Hacettepe University Adult Hospital. Only one episode of each patient was included.There were 36 patients who received P/T (4.5 g every 6 h) and 38 patients who received C/S (2 g every 8 h). Response to antimicrobial therapy was assessed. Duration of fever, neutropenia, and hospitalization; mortality rates and the necessity for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Results: The treatment success rate was 60.0% in P/T group and 63.2% in C/S group (p=0.78). There was no significant difference between the two groups in treatment success rate or mortality rate (tables). YES Age Sex COPD Diabetes2 CKD
P0688
CHF
STUDY OF PREVALENCE OF BACTERIA ISOLATED FROM BLOOD CULTURES AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN
Manijeh Mehdinejad 1 , Azar Dokht Khosravi 1 , Afroz Morvaridi 1 . 1 Dept. of Microbiology, School of Medicine, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran; 2 Ahvaz Jundi Shapour University of Medical Sciences (clinical Laboratory In Hospital Immam Khomaini), Iran Background: Bloodstream infections cause significant morbidity and mortality worldwide and are among the most common healthcare-associated infections. Aims: The aim of present study was to determine the bacteria isolated from cases of bloodstream infections and their antibiotic susceptibility pattern. Methods: During 18 months, 2790 blood culture samples were screened. The positive blood cultures were examined and the organisms were identified as per standard procedures. Antimicrobial susceptibility testing was performed for all isolates by use of disk diffusion technique, according to CLSI guidelines. Results: From total blood culture samples, 155(5.6%) were positive. The most common isolated gram negative bacilli were Klebsiella pneumoniae 52(33.5%), Eschericia coli 32(20.6%) and Enterobacter.spp 15(9.7%) and coagulase negative staphylococci (CONS) as predominant gram positive cocci, All the isolated bacteria showed the highest degree of resistance to ampicillin (98.7%), cefalexin (70.3%) and trimethoprim- sulfamethoxazole (69.7%). Gram positive cocci were also fully resistant to penicillin. In conclusion, present study revealed that both gram positive and gram negative bacteria were responsible for bloodstream infections and most of the strains were multi- drug resistant. Conclusions: The most common isolated bacteria from blood cultures were Klebsiella pneumoniae and E. coli. Ciproflexacin and vancomycin were the most effective antibiotics against gram negative bacilli and gram positive cocci respectively. Key words: blood culture, bacteremia, septicemia, antibiotics resistance
P0689 A RETROSPECTIVE STUDY COMPARING CEFOPERAZONE/SULBACTAM WITH PIPERACILLIN/TAZOBACTAM AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGICAL DISORDERS
Berivan Bitik, Sehnaz Alp, Nursel Calik Basaran, Murat Akova, Omrum Uzun, Serhat Unal. Hacettepe University Hospital Background: Febrile neutropenia is still the major cause of morbidity
S225
male female yes no yes no yes no yes
NO
p
n
%
n
%
84 1 3 1 3 1 3 3 1 1
87 1,9 8,6 3,6 5 5,3 4,3 15,8 1,4 4,3
4 52 32 27 57 18 66 16 68 22
77 98,1 91,4 96,4 95,4 94,7 95,7 84,2 98,6 95,7
Piperacillin/ Cefoperazone/ tazobactam sulbactam (36 patients) (38 patients) Duration of fever, median days (range) 2 (1-30) Duration of neutropenia, mean days (SD) ( >10 days) 19 (52.8%) Need for antibiotic change, n (%) 14 (40.0%) Antifungal addition, n (%) 7 (20%) Treatment success rate (%) 60.0%
2 (1-14) 28 (73.7%) 15 (33.5%) 5 (13%) 63.2%
0,03 0,30 1,00 1,00 0,03
p
0.97 0.062 0.96 0.43 0.78
Conclusion: This study suggests that C/S monotherapy is as effective as P/T monotherapy for febrile neutropenia in adults with hematological disorders.
P0690 TETANUS IN THE EMERGENCY DEPARTMENT: A CURRENT REVIEW BASED ON A CLINICAL CASE
Mónica Caldeira, Filipe Perneta, Susana Chaves, Luís Freitas, Rubina Miranda, Rita Rodrigues, Augusto Barros, António Caldeira. Hospital Central Do Funchal Introduction: Tetanus (TET) is a neurologic disorder, characterized by increased muscle tone and spasms caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Despite the availability of effective immunization to prevent TET, there are still up to one million cases worldwide. Although the majority of TET cases occur in third world countries, there are still significant numbers of cases occurring in countries such as Portugal, where preventive immunization is easily accessible. The Emergency Physician has the opportunity to decrease the incidence of TET identifying those at greatest risk for inadequate immunization and through providing proper wound care and immunization prophylaxis. Aims: Review of recent data about TET. Methods: Patients medical file review. Results: The authors report a clinical case of a 70 years old male, with a past medical history of Chronic Hepatitis B with the immunization plan out of date. The patient was admitted to our Emergency Department because of generalized seizure/muscle spasm while he was performing an upper endoscopy because of a 3 day’s history of dysphagia. On examination (EX): BP=143/78mmHg, HR=73bpm, Timpanic Temperature=36,3°C, Oxygen Saturation=98%; Neurological EX: GCS=15, trismus, risus sardonicus, generalized muscle spasm; wound on the second finger of the left hand with suture (inflammatory signs and second intention scarring – he had not done the passive immunization for TET in his last admission to this Hospital for
<7
Class/Days staying I II III IV V
n
%
n
%
n
%
3 3 4 14 6
42,9 60,0 21,1 34,1 33,3
3 0 7 17 1
42,9 0,0 36,8 41,5 8,3
1 2 8 10 7
14,3 40,0 42,1 24,4 58,3
Class/mortalility I II III IV V
>13
8 - 12
NO
YES
n
%
n
%
7 5 19 41 12
100 100 100 97,6 80
0 0 0 1 3
0 0 0 2,4 20
78 years. According to severity of illness 47,7% were grade IV and 21,6% grade III. Median of hospitalization stay was 10 days; in this regard, patients with CAP grade V had the highest hospitalization stay. Global mortality was 4,5% and almost all of deaths were grade V at admission. Chronic kidney disease was the only one comorbidity associated with mortality. The most used antibiotic was levofloxacin. Microbiologic data, antibiotic use and intensive care admission were not associated with mortality. Discussion & conclusion: Majority of patients with CAP who requires hospitalization were grade IV at the moment of admission. Grade V of disease was related with the highest rate of mortality and extended hospitalization. Chronic kidney disease was the only one comorbidity associated with mortality. Keywords: Pneumonia, pneumonia severity index.
and mortality in patients with hematologic malignancies. Empirical broadspectrum antibiotic therapy remains the cornerstone of treatment for febrile neutropenic episodes since bacterial infections are the most common etiologic agents in these episodes. While piperacillin/tazobactam (P/T) monotherapy has been found to be effective in the treatment of neutropenic adult patients, there are no data for cefoperazone/sulbactam (C/S) monotherapy in this population. We evaluated the efficacy of C/S and P/T monotherapy for the empirical treatment of febrile neutropenia in adult patients with hematologic malignancies. Methods: Hospital records of 74 patients were reviewed retrospectively from January 1, 2007 to January 1, 2008 at Hacettepe University Adult Hospital. Only one episode of each patient was included.There were 36 patients who received P/T (4.5 g every 6 h) and 38 patients who received C/S (2 g every 8 h). Response to antimicrobial therapy was assessed. Duration of fever, neutropenia, and hospitalization; mortality rates and the necessity for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Results: The treatment success rate was 60.0% in P/T group and 63.2% in C/S group (p=0.78). There was no significant difference between the two groups in treatment success rate or mortality rate (tables). YES Age Sex COPD Diabetes2 CKD
P0688
CHF
STUDY OF PREVALENCE OF BACTERIA ISOLATED FROM BLOOD CULTURES AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN
Manijeh Mehdinejad 1 , Azar Dokht Khosravi 1 , Afroz Morvaridi 1 . 1 Dept. of Microbiology, School of Medicine, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran; 2 Ahvaz Jundi Shapour University of Medical Sciences (clinical Laboratory In Hospital Immam Khomaini), Iran Background: Bloodstream infections cause significant morbidity and mortality worldwide and are among the most common healthcare-associated infections. Aims: The aim of present study was to determine the bacteria isolated from cases of bloodstream infections and their antibiotic susceptibility pattern. Methods: During 18 months, 2790 blood culture samples were screened. The positive blood cultures were examined and the organisms were identified as per standard procedures. Antimicrobial susceptibility testing was performed for all isolates by use of disk diffusion technique, according to CLSI guidelines. Results: From total blood culture samples, 155(5.6%) were positive. The most common isolated gram negative bacilli were Klebsiella pneumoniae 52(33.5%), Eschericia coli 32(20.6%) and Enterobacter.spp 15(9.7%) and coagulase negative staphylococci (CONS) as predominant gram positive cocci, All the isolated bacteria showed the highest degree of resistance to ampicillin (98.7%), cefalexin (70.3%) and trimethoprim- sulfamethoxazole (69.7%). Gram positive cocci were also fully resistant to penicillin. In conclusion, present study revealed that both gram positive and gram negative bacteria were responsible for bloodstream infections and most of the strains were multi- drug resistant. Conclusions: The most common isolated bacteria from blood cultures were Klebsiella pneumoniae and E. coli. Ciproflexacin and vancomycin were the most effective antibiotics against gram negative bacilli and gram positive cocci respectively. Key words: blood culture, bacteremia, septicemia, antibiotics resistance
P0689 A RETROSPECTIVE STUDY COMPARING CEFOPERAZONE/SULBACTAM WITH PIPERACILLIN/TAZOBACTAM AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN ADULTS WITH HEMATOLOGICAL DISORDERS
Berivan Bitik, Sehnaz Alp, Nursel Calik Basaran, Murat Akova, Omrum Uzun, Serhat Unal. Hacettepe University Hospital Background: Febrile neutropenia is still the major cause of morbidity
S225
male female yes no yes no yes no yes
NO
p
n
%
n
%
84 1 3 1 3 1 3 3 1 1
87 1,9 8,6 3,6 5 5,3 4,3 15,8 1,4 4,3
4 52 32 27 57 18 66 16 68 22
77 98,1 91,4 96,4 95,4 94,7 95,7 84,2 98,6 95,7
Piperacillin/ Cefoperazone/ tazobactam sulbactam (36 patients) (38 patients) Duration of fever, median days (range) 2 (1-30) Duration of neutropenia, mean days (SD) ( >10 days) 19 (52.8%) Need for antibiotic change, n (%) 14 (40.0%) Antifungal addition, n (%) 7 (20%) Treatment success rate (%) 60.0%
2 (1-14) 28 (73.7%) 15 (33.5%) 5 (13%) 63.2%
0,03 0,30 1,00 1,00 0,03
p
0.97 0.062 0.96 0.43 0.78
Conclusion: This study suggests that C/S monotherapy is as effective as P/T monotherapy for febrile neutropenia in adults with hematological disorders.
P0690 TETANUS IN THE EMERGENCY DEPARTMENT: A CURRENT REVIEW BASED ON A CLINICAL CASE
Mónica Caldeira, Filipe Perneta, Susana Chaves, Luís Freitas, Rubina Miranda, Rita Rodrigues, Augusto Barros, António Caldeira. Hospital Central Do Funchal Introduction: Tetanus (TET) is a neurologic disorder, characterized by increased muscle tone and spasms caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Despite the availability of effective immunization to prevent TET, there are still up to one million cases worldwide. Although the majority of TET cases occur in third world countries, there are still significant numbers of cases occurring in countries such as Portugal, where preventive immunization is easily accessible. The Emergency Physician has the opportunity to decrease the incidence of TET identifying those at greatest risk for inadequate immunization and through providing proper wound care and immunization prophylaxis. Aims: Review of recent data about TET. Methods: Patients medical file review. Results: The authors report a clinical case of a 70 years old male, with a past medical history of Chronic Hepatitis B with the immunization plan out of date. The patient was admitted to our Emergency Department because of generalized seizure/muscle spasm while he was performing an upper endoscopy because of a 3 day’s history of dysphagia. On examination (EX): BP=143/78mmHg, HR=73bpm, Timpanic Temperature=36,3°C, Oxygen Saturation=98%; Neurological EX: GCS=15, trismus, risus sardonicus, generalized muscle spasm; wound on the second finger of the left hand with suture (inflammatory signs and second intention scarring – he had not done the passive immunization for TET in his last admission to this Hospital for