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Biomedical subjects

C Viscoli

Publications and source records attributed to C Viscoli.

At least 73 records · Page 4Linked to original sources
PubMed1991

Serum concentrations and safety of single daily dosing of amikacin in children undergoing bone marrow transplantation.

The serum concentrations and safety of single daily dosing of amikacin were studied in 16 episodes of fever and granulocytopenia in children undergoing bone marrow transplantation. Amikacin (20 mg/kg) was administered as a 20 min iv infusion once daily for 7 to 19 days; all patients received concomitant therapy with ceftazidime. Peak amikacin concentrations measured immediately after infusion on day 1 and 4 of therapy averaged 72.29 +/- 11.6 mg/l and 74.02 +/- 19.29 mg/l respectively. A slight but statistically significant increase 30 minute post-infusion concentrations was observed in most patients during therapy. Serum amikacin were less than 3 mg/l in all trough samples and within 6 h post-infusion in most patients. A significant increase in serum creatinine was observed in one patient, who was also receiving cyclosporin A. Auditory function was evaluated in 10 patients and showed no changes. Although other drugs were added to cover Gram-positive or fungal pathogens, all patients survived. These data combined with the recent experience of single daily dose amikacin in adults supports further evaluation of novel dosage regimens of aminoglycosides in children.

Adolescent↗
PubMed1991

Fluconazole in the treatment of candidiasis in immunocompromised children.

Fluconazole, a new triazole derivative, was evaluated in a pilot study of 34 episodes of candidiasis in 24 children. All the patients had predisposing conditions, such as human immunodeficiency virus infection, cancer, organ or bone marrow transplantation, neonatal age and malnutrition, and obstructive uropathy. The drug was administered at 6 mg/kg (body weight) once daily either orally or intravenously. Two patients with fungemia due to Candida parapsilosis required an increased dosage of 12 mg/kg. Clinical and microbiological success was achieved in 30 of 34 cases (88%). Drug-related transaminase increases were observed in two cases (6%). Fluconazole may represent an effective alternative to amphotericin B in the treatment of candidiasis in children. Comparative trials are necessary to assess optimal dosages and efficacy.

Adolescent↗
PubMed1991

Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors. The European Organization for Research on Treatment of Cancer International Antimicrobial Therapy Cooperative Group.

Empiric therapy for febrile granulocytopenic patients is mandatory, but whether monotherapy is a safe alternative and whether fluoroquinolones are useful agents for this indication are still controversial issues. The use of monotherapy with intravenous ciprofloxacin (200 to 300 mg every 12 h) was evaluated against combined therapy with piperacillin plus amikacin in febrile granulocytopenic patients with solid tumor or lymphoma. The study was discontinued prematurely because patients treated with ciprofloxacin had a significantly lower overall success rate than patients treated with piperacillin plus amikacin (31 of 48 patients [65%] versus 48 of 53 patients [91%], P = 0.002). Patients with gram-positive coccal bacteremia had a particularly poor outcome: therapy failed for six of eight patients (75%) treated with ciprofloxacin, while therapy failed for none of four patients treated with piperacillin plus amikacin. Death from primary infection during initially randomized protocol therapy occurred in 7 of 48 patients (14.5%) treated with ciprofloxacin and in 3 of 53 (6%) treated with piperacillin plus amikacin. This study does not support the use of this dose of intravenous ciprofloxacin as empiric monotherapy for fever in granulocytopenic patients.

Adult↗
PubMed1991

Myeloablative therapy and unpurged autologous bone marrow transplantation for poor-prognosis neuroblastoma: report of 34 cases.

From October 1984 to November 1987, 34 patients aged from 1 year 1 month to 7 years 7 months with resistant or relapsed neuroblastoma (NB) (group 1, 10 patients), unselected disseminated NB (group 2, 14 patients), or selected disseminated NB (group 3, 10 patients) received myeloablative therapy (MAT) followed by unpurged autologous bone marrow transplantation (ABMT) at the end of an intensive protocol, which included high-dose chemotherapy and surgery to the primary tumor. Median time from diagnosis to MAT and ABMT was 6 months (5 months from last relapse to MAT and ABMT in the relapsed patients). The MAT regimen included vincristine, fractionated total body irradiation (TBI), and melphalan. Seventeen patients were grafted in complete remission (CR), five in very good partial remission (VGPR), 10 in partial remission (PR), and two in progressive disease (PD). The acute toxic death rate was 2.9%. The overall progression-free survival was 29%. The median progression-free survival was 20 months for the 17 patients grafted in CR, 6 months for the five patients grafted in VGPR, and 12 months for the 10 patients grafted in PR.

Adolescent↗
PubMed1990

Infection with Fusarium species in two children with neuroblastoma.

Two cases of Fusarium infection in children with neuroblastoma are reported. One of the patients had an overwhelming infection and the diagnosis was based on isolation of Fusarium moniliforme from blood and skin biopsy, and histological findings. The second patient developed chronic polyarthritis and Fusarium solani was cultured from synovial fluid samples taken from two different joints four months apart. No histological documentation of infection was obtained. The response to antifungal therapy was unfavourable. Both patients died, but in the second case the relationship between fungal infection and death was not established.

Amikacin↗
PubMed1988

Aspects of infections in children with cancer.

There are some differences between pediatric and adult cancer patients in terms of the problem of infection but it is doubtful whether such discrepancies justify different therapeutic approaches. For example, according to the results of EORTC trial IV, children seem to show lower overall (3% vs 19%) and infectious (2% vs 8%) mortality than adults, probably due to differences in underlying diseases and to a basic better physical integrity. Central intravenous catheters appear to be indispensable in the modern management of neoplastic diseases, especially in pediatric oncology. A prospective study performed in our institution on 157 Broviac catheters, has shown: 1. Of all microbiologically documented infections, occurring in children undergoing cancer chemotherapy and radiotherapy, 27% are related to the catheter 2. Gram-positive cocci are the leading pathogens (78%) of such infections 3. Catheter-related infections often occur in non-neutropenic patients 4. Such infections can be successfully treated without removing the intravenous device. The experience of the EORTC Cooperative Group and of other centers throughout the world shows that gram-positive cocci are increasingly being isolated as the cause of infections in cancer patients. This phenomenon is probably multifactorial in origin and appears to be more evident in pediatrics. For example, in our institution, during the last 5 years gram-positive organisms have caused 69% of all bacteremias. Moreover, these organisms, while responding poorly to the presently used empirical antibiotic regimens, seem not to be as aggressive as gram-negative organisms and cause lower mortality. There is therefore controversy over whether or not to include anti-gram-positive coverage in early empirical regimens. In our institution, a pilot study comparing ceftazidime + amikacin (C + A) and ceftazidime + vancomycin (C + V) seems to show an overall advantage for C + V. This advantage, however, is not statistically significant. One finding to be pointed out is that five of ten staphylococcal infections failed to respond to C + V and that in these cases a third antibiotic had to be added. Therefore, it is likely that, at least in institutions in which methicillin-resistant staphylococci are prevalent, a triple antibiotic empirical regimen will provide the best coverage, but this can result in overtreatment. However, only prospective, randomized and multicenter trials will be able to answer such questions definitely.

Anti-Bacterial Agents↗
PubMed1988

Gram-positive infections in granulocytopenic patients: an important issue?

Gram-positive pathogens have become a common cause of bacteraemia in granulocytopenic cancer patients. This has been partially attributed to the use of central intravenous devices such as Hickman catheters; mucositis secondary to intensive antineoplastic chemotherapy or herpes infections may also be the source, especially for streptococci, whereas the skin is most probably the source for Staphylococcus epidermidis. Antimicrobial prophylaxis recommended mainly with the aim of reducing the incidence of Gram-negative bacillary infections may also play a significant role. The rate of response of documented infections caused by Gram-positive cocci to 'standard' empirical therapy (which has been mainly directed against Gram-negative bacilli) has been unsatisfactory although the lethality reported has been low. These results raise an important question, whether or not a specific anti-Gram-positive antibiotic such as vancomycin, should be added to the empirical regimen. A recent study suggested that empirical vancomycin provided no benefit since the mortality due to Gram-positive infections was low and a favourable outcome was obtained by adding a specific antibiotic after bacteriological documentation. However, others have shown that empirical use of vancomycin was associated with a more rapid resolution of fever. Vancomycin has been associated with an excess rate of side-effects and is difficult to administer. Another important question is whether or not antimicrobial prophylaxis for gut decontamination should include anti-Gram-positive cover. Recent studies have confirmed that Gram-negative bacillary bacteraemia may be prevented by oral gut decontamination but not bacteraemia due to Gram-positive bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Agranulocytosis↗
PubMed1988

Role of Broviac catheters in infections in children with cancer.

In a 3-year period 157 single lumen Broviac catheters were inserted in 145 children with various neoplastic diseases. The overall duration of the catheter courses was 30,533 days (median, 171; range, 2 to 647). Sixty-five percent of the catheter courses (102 of 157) were complicated by at least 1 febrile episode, for a total of 157 episodes. According to European Organization for Research on Treatment of Cancer criteria, 79 febrile episodes (50%) were classified as microbiologically documented infections, 57 (36%) with and 22 (14%) without septicemia; 31 (20%) as clinically documented infections; and 47 (30%) as possible infections. Of the 79 microbiologically documented infections 21 were catheter-related infections (CRI), 32 were catheter-unrelated infections and 26 were infections of unknown source. Only 48% of CRI occurred during neutropenia (less than 1000 neutrophils/mm3), compared with 88% of catheter-unrelated infections and 96% of infections of unknown origin (P = 0.00007). Gram-positive microorganisms (56% staphylococci) accounted for 78% of all isolates in CRI, 47% in catheter-unrelated infections and 43% in infections of unknown origins (P = 0.03). Fungi represented 12% of all isolates. Clinical and microbiologic resolution without removal of the catheter was achieved in 12 of 21 CRI (57%) and no patient died from a CRI. This study indicates that over 3 of 4 of CRI are caused by Gram-positive bacteria, occur in neutropenic and non-neutropenic patients (approximately 50%) and can be successfully treated without removing the catheter.

Adolescent↗
PubMed1988

Empiric antimicrobial therapy for febrile granulocytopenic cancer patients: lessons from four EORTC trials.

The results of the four EORTC trials conducted over the past 15 years suggest: (1) early empiric therapy with broad spectrum antibiotics directed against gram-negative bacterial bacteremia (GNBB) is a reasonable approach in febrile granulocytopenic patients (GCP); (2) the level and dynamics of the granulocyte count are extremely important in determining the outcome of bacteremia; severely and/or persistently neutropenic patients are the true tests of antibiotic efficacy and they benefit from antimicrobial synergism; (3) mortality from GNBB in GCP is not related directly to a given empiric antimicrobial regimen which may 'buy time' and allow appropriate therapeutic alterations; (4) only microbiologically documented infections and especially bacteremias are useful to compare responses to antimicrobial regimens; (5) the response rate of GNBB is clearly influenced by the susceptibility of the causative pathogen to the beta-lactam component of the empiric regimen and emergence of resistance to some antibiotics (cephalothin, carbenicillin, ticarcillin, azlocillin) has rendered some combinations less effective. The combination of an anti-Pseudomonas beta-lactam plus an aminoglycoside is recommended as the 'standard' for empiric therapy in febrile GCP; (6) gram-positive pathogens have become a common cause of bacteremia in GCP and although the response rate to empiric regimens may be marginal, the associated mortality is low. A general conclusion from these trials is that studies of the management of infection in GCP should include sufficient numbers of eligible patients to allow for evaluation of bacteremic patients at highest risk of death. The need for large collaborative studies stems directly from these considerations.

Agranulocytosis↗
PubMed1987

Emerging microorganisms in cystic fibrosis.

Pseudomonas aeruginosa is the most common bacterial isolate obtained from patients with cystic fibrosis of the lungs. Recently, however, new multiresistant organisms have emerged, whose identification may be difficult and whose pathogenic role proves hard to define. Of the 71 strains isolated from 24 patients with cystic fibrosis during acute flareups of pulmonary symptoms, 48 turned out to be Pseudomonas aeruginosa (67.6%); 11 were Pseudomonas non-aeruginosa (15.5%); and 12 were Achromobacter xylosoxidans (16.9%). Each bacterial isolate was tested for sensitivity to nine antibiotics (ceftazidime, azlocillin, piperacillin, aztreonam, cefsulodin, cefoperazone, amikacin, tobramycin, and sisomycin) in terms of minimum inhibitory concentration and minimum bactericidal concentration values. In this series, Achromobacter xylosoxidans proved the species least responsive to treatment, and ceftazidime the most active antibiotic both against Achromobacter and against strains of the genus Pseudomonas. Twenty-three different associations of ceftazidime with aminoglycosides, tested for activity on the multiresistant strains, failed to show synergism of action.

Alcaligenes↗
PubMed1985

Evaluation of ceftazidime in the treatment of 80 infectious episodes in compromised children.

The efficacy of ceftazidime in the treatment of infections in compromised children was evaluated in 80 such episodes occurring in 64 patients with various underlying diseases. Among the patients treated, 9 were newborns with severe neonatal distress, 21 were children with cancer and neutropenia, 8 were surgical patients, 22 had cystic fibrosis and 4 were suffering from meningitis. The following types of infections were treated: 19 bacteriologically documented and 8 possible septicemias (the latter only in newborns and neutropenic cancer patients); 2 severe upper respiratory tract infections in cancer patients; 8 soft tissue or skin infections; 1 cholangitis; 1 pneumonia; 1 osteomyelitis; 1 mediastinitis; 35 infectious exacerbations of underlying pulmonary disease in cystic fibrosis patients; and 4 meningitides. In almost all cases ceftazidime was administered intravenously in combination with an aminoglycoside. In 2 cases it was also given intrathecally or intraventricularly. Bacteriological documentation was achieved in 70 out of 80 episodes. A successful outcome was obtained in 79% of the cases with slight and statistically nonsignificant differences between groups of patients with different etiological patterns in terms of prevalence of gram-positive microorganisms. Tolerance of the treatment was uniformly good, only one patient showing a mild, transient transaminase elevation.

Adolescent↗