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Biomedical subjects

R Bolivar

Publications and source records attributed to R Bolivar.

At least 19 recordsLinked to original sources
PubMed1985

Cefotaxime: single agent therapy for infections in cancer patients with adequate granulocyte counts.

Seventy-eight infectious episodes in 75 cancer patients with adequate granulocyte counts were treated with cefotaxime. Sixty-six episodes were evaluable. The overall cure rate was 77% (51/66). The response rate in 46 episodes where an organism was identified was 72% (33/46). Gram-positive and Gram-negative infections responded equally with rates of 81% and 80% respectively. Pneumonia, septicaemia and urinary tract infections occurred most frequently and had response rates of 62% (18/29), 90% (9/10) and 91% (10/11) respectively. Polymicrobial infections were associated with a poor response--40% (4/10). No serious adverse effects occurred. Cefotaxime as a single agent was effective therapy for most Gram-positive and Gram-negative infections in cancer patients with adequate granulocyte counts. Polymicrobial infections and Gram-negative pneumonias might require additional agents.

Adult↗
PubMed1984

Activity of beta-lactamase inhibitors in combination with new beta-lactam antibiotics against resistant gram-negative organisms.

Thirty-eight isolates of gram-negative bacilli resistant to four new beta-lactam antibiotics, aztreonam, moxalactam, ceftazidime, and cefoperazone, were tested in the presence of two beta-lactam inhibitors, clavulanic acid and sulbactam. Microorganisms tested included 22 isolates of Pseudomonas species, 5 of Klebsiella species, and 11 of Enterobacter species. A 2- to 10-fold decrease in minimum inhibitory concentration was noted when antibiotics and beta-lactamase inhibitors were combined compared to antibiotics alone. Four strains of Pseudomonas aeruginosa showed increased resistance to the combination of antibiotics and beta-lactamase inhibitors.

Anti-Bacterial Agents↗
PubMed1984

Polymicrobial brain abscess in a homosexual man with Kaposi's sarcoma.

A progressive visual field defect and fever occurred in a 39-year-old homosexual man with acquired immunodeficiency syndrome and Kaposi's sarcoma. Computerized tomography of the brain documented a left parieto-occipital abscess. A specimen obtained at the time of surgical excision of the lesion revealed organisms with morphologic features of Toxoplasma gondii and Candida. Culture of this material grew Staphylococcus epidermidis. Appropriate therapy for this polymicrobial infection resulted in resolution of the fever and clinical improvement. The visual deficit remained unchanged despite antimicrobial therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Piperacillin plus vancomycin in the therapy of febrile episodes in cancer patients.

Piperacillin and vancomycin were used as initial empirical therapy for 211 febrile episodes in cancer patients. The response rate in 95 episodes of documented infection was 72%. The response of bacteremias, soft tissue infections, and pneumonias was 78, 71, and 38%, respectively. The response in infections caused by gram-negative organisms was 73%. Only 6 of 10 Pseudomonas aeruginosa infections responded to therapy, although the organisms were sensitive in vitro to piperacillin. Of 14 infections caused by gram-positive organisms, 12 responded to this combination. No major side effects were observed with this regimen. Although the overall response rate with this antibiotic combination was comparable with other regimens used for neutropenic patients, superior results might be obtained by combining piperacillin with an extended-spectrum cephalosporin or an aminoglycoside.

Bacterial Infections↗
PubMed1984

Bacteremia caused by Campylobacter-like organisms in two male homosexuals.

Bacteremia caused by newly described Campylobacter-like organisms occurred in two immunosuppressed homosexual patients with tuberculosis. Although these organisms grow well in aerobic bottles using a radiometric blood culture system, they are not readily seen in gram-stained smears and are easily missed if routine subculture methods are used. Microscopic examination of wet preparations and subculture to brucella agar base supplemented with 10% sheep blood and incubated in microaerophilic conditions are useful for identification and isolation. The recovery of Campylobacter-like organisms from the blood suggests that these organisms, formerly known only to be associated with proctocolitis or asymptomatic rectal infection in homosexual men, can also cause systemic infection in these patients.

Adult↗
PubMed1984

Moxalactam plus ticarcillin or tobramycin for treatment of febrile episodes in neutropenic cancer patients.

Moxalactam disodium in combination with ticarcillin disodium or tobramycin sulfate was used to treat 445 episodes of suspected or confirmed infection in patients with cancer. The majority had leukemia and neutropenia. The rate of cures during the 231 confirmed infections was 65% for moxalactam and ticarcillin and 64% for moxalactam and tobramycin. Both regimens were comparable against aerobic gram-negative and polymicrobial infections. In gram-positive infections, the response rate for moxalactam and ticarcillin was 73% and for moxalactam and tobramycin, 53%. Only three of nine enterococcal infections responded to treatment. Thirteen percent of all organisms recovered were resistant to moxalactam. Side effects occurred infrequently; the most important was coagulopathy due to moxalactam. Nephrotoxic effects occurred in six patients receiving moxalactam and tobramycin and in none of those receiving moxalactam and ticarcillin. In 39 patients, a superinfection was confirmed. Fourteen were fungal, three were due to enterococcus, and one due to Klebsiella species. Eleven of the 14 fungal episodes occurred in the moxalactam-ticarcillin group. Moxalactam with ticarcillin and moxalactam with tobramycin are equally active for the initial treatment of presumed infection in patients with neutropenia.

Adolescent↗
PubMed1983

Aspergillus epiglottitis.

A 21-year-old woman with acute lymphocytic leukemia developed clinical and radiographic signs of epiglottitis. Premortem and postmortem histologic studies showed invasive aspergillosis; Aspergillus flavus was grown in culture. The necrotizing nature of this infection is explained by the predilection of Aspergillus sp. for invasion of blood vessels. The usual causative agents of epiglottitis are bacteria; the association with fungal infection has not been previously described.

Adult↗
PubMed1983

Human cryptosporidiosis: spectrum of disease. Report of six cases and review of the literature.

Although once regarded exclusively as an animal parasite, Cryptosporidium has emerged during the last decade as a cause of diarrhea in humans. Of the 43 cases of human cryptosporidiosis reported, 27 patients in whom either humoral or cell-mediated immune defects were present had chronic protracted diarrhea that was almost invariably unresponsive to therapy and culminated in death. In contrast, 16 patients with intact immune systems had either self-limited disease or were asymptomatic. Animal exposure was almost exclusively recorded in the latter group. During the last six months at University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, gastrointestinal (GI) tract cryptosporidiosis developed in six homosexual men with acquired immune deficiency syndrome (AIDS). The diagnosis of cryptosporidiosis was established histologically in five patients. In four, cryptosporidial oocysts were detected in the stool. In addition to extensive GI tract cryptosporidiosis, two patients had biliary tract involvement. Multiple chemotherapeutic agents failed to control the disease, and five patients eventually died. Cryptosporidiosis should be considered in the differential diagnosis of diarrhea, in animal handlers or in the severely compromised patient, especially one with AIDS, who has chronic protracted diarrhea.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Coagulation abnormalities induced by beta-lactam antibiotics in cancer patients.

The records of 714 neutropenic cancer patients who were treated with high doses of a combination of beta-lactam antibiotics were analyzed. In 268 patients, coagulation parameters were measured at least once before, during, and after therapy. Alterations on the prothrombin time, activated partial thromboplastin time, and thrombin time were found in those regimens containing a semisynthetic penicillin, cefamandole, and moxalactam. Mild and severe hemorrhage was observed in some patients receiving these regimens. After prophylactic administration of vitamin K to all patients treated with moxalactam, no further hemorrhage was noted. Alteration of the prothrombin time, with preservation of other parameters, was found in patients receiving antibiotic regimens containing semisynthetic penicillin and cefoxitin. No evidence of hemorrhage was found in this group of patients. In neutropenic cancer patients, the occurrence of another impairment in the clotting process, in addition to thrombocytopenia, greatly increases the risk of serious hemorrhage. Coagulation parameters must be routinely monitored when these patients receive antibiotics known to cause coagulation abnormalities.

Anti-Bacterial Agents↗
PubMed1983

A randomized study of ceftazidime compared to ceftazidime and tobramycin for the treatment of infections in cancer patients.

Three hundred and twenty-one febrile episodes in cancer patients were treated with ceftazidime alone or in combination with tobramycin. Patients were grouped according to their neutrophil count into neutropenic and non-neutropenic (less than 1000 and greater than 1000/mm3) respectively. Two hundred and seventy-five episodes were evaluated. The overall response rate in 83 episodes of infection treated with ceftazidime alone was 60 and 73% in those who received the combination. In those bacteriologically proven the response rate was 72% in both groups of the study. The overall response rate in septicaemia was 75% with ceftazidime alone and 85% with the combination. High response rates were obtained in Gram-negative bacillary septicaemias in both groups even in neutropenic patients treated with ceftazidime alone. Pneumonias in neutropenic patients responded equally well. However, patients with adequate neutrophil counts responded better to the combination than to single-agent therapy. The response rate for Gram-positive infections was 41% for ceftazidime alone and 57% for the combination, which was inferior to the results obtained for Gram-negative infections (P = 0.001). The rates of superinfection and toxicity were very low. Ceftazidime is a useful antibiotic against Gram-negative infections in cancer patients. It should be combined with an agent active against Gram-positive pathogens in neutropenic patients.

Adolescent↗
PubMed1983

Effects of hepatic function on vancomycin clinical pharmacology.

Using a recently developed radioimmunoassay, we performed 15 vancomycin pharmacology studies in cancer patients with infections. Vancomycin (500 mg) was infused intravenously for 30 min every 6 h for up to 7 days. The plasma disappearance curve was biphasic, with an initial half-life of less than 30 min. The second half-life (t1/2 beta), not dose related, varied from 1.4 to 231 h among the patients. In six studies of patients with normal hepatic functions, the t1/2 beta was 2.6 h; the rate of total clearance was 162 ml/min. In contrast, nine studies of patients with impaired liver function had a much longer t1/2 beta (37 h) and a decrease in the rate of total clearance to 48 ml/min. These factors resulted in an increase in the value of area under the concentration-time curve from 59 to 3,434 micrograms X h/ml. These results have demonstrated the importance of the effects of liver function on vancomycin disposition. The vancomycin dose and schedule should be adjusted for patients with liver impairment.

Adult↗
PubMed1983

Bacteremia caused by a previously unidentified species of rapidly growing Mycobacterium successfully treated with vancomycin.

Bacteremia caused by rapidly growing mycobacteria are usually due to Mycobacterium fortuitum or M. chelonei. Other rapidly growing mycobacteria generally are considered to be nonpathogenic. We report the case of a patient with bacteremia due to an unidentified, rapidly growing, scotochromogenic mycobacteria that was detected by a radiometric blood culture system. Results of in-vitro susceptibility testing indicated that the organism was susceptible to vancomycin and other antimicrobial agents, and the patient was successfully treated with vancomycin. We believe that this is the first report of successful use of vancomycin therapy for a mycobacterial infection.

Aged↗