1
|
Ishikawa K, Nakamura T, Kawai F, Ota E, Mori N. Systematic Review of Beta-Lactam vs. Beta-Lactam plus Aminoglycoside Combination Therapy in Neutropenic Cancer Patients. Cancers (Basel) 2024; 16:1934. [PMID: 38792012 DOI: 10.3390/cancers16101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
We performed a systematic review of studies that compared beta-lactams vs. beta-lactams plus aminoglycosides for the treatment of febrile neutropenia in cancer patients. METHOD We searched CENTRAL, MEDLINE, and Embase for studies published up to October 2023, and randomized controlled trials (RCTs) that compared anti-Pseudomonas aeruginosa beta-lactam monotherapy with any combination of an anti-Pseudomonas aeruginosa beta-lactam and an aminoglycoside were included. RESULT The all-cause mortality rate of combination therapy showed no significant differences compared with that of monotherapy (RR 0.99, 95% CI 0.84 to 1.16, high certainty of evidence). Infection-related mortality rates showed that combination therapy had a small positive impact compared with the intervention with monotherapy (RR 0.83, 95% CI 0.66 to 1.05, high certainty of evidence). Regarding treatment failure, combination therapy showed no significant differences compared with monotherapy (RR 0.99, 95% CI 0.94 to 1.03, low certainty of evidence). In the sensitivity analysis, the treatment failure data published between 2010 and 2019 showed better outcomes in the same beta-lactam group (RR 1.10 [95% CI, 1.01-1.19]). Renal failure was more frequent with combination therapy of any daily dosing regimen (RR 0.46, 95% CI 0.36 to 0.60, high certainty of evidence). CONCLUSION We found combining aminoglycosides with a narrow-spectrum beta-lactam did not spare the use of broad-spectrum antibiotics. Few studies included antibiotic-resistant bacteria and a detailed investigation of aminoglycoside serum levels, and studies that combined the same beta-lactams showed only a minimal impact with the combination therapy. In the future, studies that include the profile of antibiotic-resistant bacteria and the monitoring of serum aminoglycoside levels will be required.
Collapse
Affiliation(s)
- Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Fujimi Kawai
- Library, Department of Academic Resources, St. Luke's International University, Tokyo 104-0044, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, Tokyo 104-0044, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-0032, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan
| |
Collapse
|
2
|
Hewamana S, Skandarajah T, Jayasinghe C, Deshapriya S, Gayashan D, Peiris N, Harischandra M, Gunasena P, Somasundaram G, Srinivasan V, Somiah S, Wickramarathna C, Hewawasam S, Balawardena J, Arseculeratne G, Wadanamby R, Galagoda G, Wijesiriwardana B. Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting. JCO Glob Oncol 2024; 10:e2300412. [PMID: 38484192 PMCID: PMC10954079 DOI: 10.1200/go.23.00412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Sepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients. MATERIALS AND METHODS Retrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed. RESULTS A total of 169 neutropenic episodes were identified; 115 (68%) of such episodes were related to chemotherapy. Acute leukemia, lymphoproliferative disorders, and plasma cell disorders accounted for 23%, 69%, and 8% of patients, respectively. The median age of patients who had sepsis was 56 years, whereas that of those who had no sepsis was 53 years (P = .49). The median time to neutropenia was 9 days for those in the sepsis group compared with 8 days in the group that had no sepsis (0.64). The median neutrophil count in the group that had sepsis was 0.06, whereas it was 0.69 in the group that had no sepsis (P ≤ .05). The median time to commencement of antibiotics was 20 minutes. CONCLUSION To our knowledge, this is the only documented study related to outcome and successful applicability of western supportive care protocols to Sri Lankan patients with neutropenia. In this study, we have shown that neutropenic sepsis can be successfully managed in the setting of limited resources with service development, following guidelines and staff training.
Collapse
Affiliation(s)
| | | | - Chathuri Jayasinghe
- Department of Statistics, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Lionel SA, Selvarajan S, Korula A, Kulkarni U, Devasia A, Abubacker FN, Abraham A, Mathews V, Lakshmi KM, George B. Profile and Predictors of Infection Following Anti-thymocyte Globulin or Anti-lymphocyte Globulin with Cyclosporine in Aplastic Anemia. Indian J Hematol Blood Transfus 2023; 39:419-428. [PMID: 37304482 PMCID: PMC10247602 DOI: 10.1007/s12288-022-01597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
Immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and Cyclosporine (CSA) in aplastic anaemia (AA) results in improvement of blood counts between 3 and 6 months for the majority of patients. Infection is the most lethal complication in aplastic anemia and may arise due to several factors. We performed this study to determine the prevalence and predictors of specific infection types before and after IST. Six hundred and seventy-seven (546 adults; 434 males) transplant ineligible patients received ATG and CSA between 1995 and 2017. All patients who were transplant ineligible and received IST in this period were included. Infections before IST was seen in 209 (30.9%) and in 430 (63.5%) patients post IST. There were 700 infective episodes in the six months post-IST, including 216 bacterial, 78 fungal, 33 viral, and 373 culture-negative febrile episodes. Infections were highest (98, 77.8%) in very severe aplastic anaemia as compared to Severe AA (SAA) and Non-Severe AA (NSAA) (p < 0.001). Infections were also significantly higher in those who did not respond to ATG (71.1% vs. 56.8%, p = 0.003). At six months post-IST were 545 (80.5%) alive, and there were 54 (7.9%) deaths due to infection. Significant predictors of mortality were paediatric AA, very severe aplastic anaemia, pre or post ATG infections, and lack of response to ATG. Mortality was highest in those with combined bacterial and fungal infections post IST (p < 0.001). We conclude that infections are a common complication (63.5%) of IST. Mortality was highest when both bacterial and fungal infections were present. Routine use of growth factors and prophylactic antifungal and antibacterial agents was not part of our protocol, despite which 80.5% of the cohort was alive at the end of six months.
Collapse
Affiliation(s)
| | - Sushil Selvarajan
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Uday Kulkarni
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Anup Devasia
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Fouzia N. Abubacker
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Aby Abraham
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Kavitha M. Lakshmi
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu India
| |
Collapse
|
4
|
Wu C, Guo L, Muhataer X, Li Q, Lian Z, Li Y, Wang W, Ding W, Zhou Y, Yang X, Chen M. Interaction between the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count in rats with LPS-induced pulmonary infection. Open Life Sci 2023; 18:20220588. [PMID: 37077346 PMCID: PMC10106970 DOI: 10.1515/biol-2022-0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 04/21/2023] Open
Abstract
This study examined the effects of the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count after pulmonary infection. Sprague‒Dawley rats were subjected to tracheal injection of lipopolysaccharide (LPS) to establish animal models of pulmonary infection. By inhibiting the PI3K/AKT pathway or inhibiting/inducing mitochondrial autophagy in macrophages, the severity of the pulmonary infection and the leukocyte count were altered. The PI3K/AKT inhibition group did not show a significant difference in leukocyte counts compared with the infection model group. Mitochondrial autophagy induction alleviated the pulmonary inflammatory response. The infection model group had significantly higher levels of LC3B, Beclin1, and p-mTOR than the control group. The AKT2 inhibitor group exhibited significantly increased levels of LC3B and Beclin1 compared with the control group (P < 0.05), and the Beclin1 level was significantly higher than that in the infection model group (P < 0.05). Compared with the infection model group, the mitochondrial autophagy inhibitor group exhibited significantly decreased levels of p-AKT2 and p-mTOR, whereas the levels of these proteins were significantly increased in the mitochondrial autophagy inducer group (P < 0.05). PI3K/AKT inhibition promoted mitochondrial autophagy in macrophages. Mitochondrial autophagy induction activated the downstream gene mTOR of the PI3K/AKT pathway, alleviated pulmonary inflammatory reactions, and decreased leukocyte counts.
Collapse
Affiliation(s)
- Chao Wu
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Lianghua Guo
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, 355000Fu’an City, China
| | - Xirennayi Muhataer
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Qifeng Li
- Xinjiang Institute of Pediatrics, Children’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi830054, China
| | - Zhichuang Lian
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Yafang Li
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Wenyi Wang
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Wei Ding
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Yuan Zhou
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Xiaohong Yang
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, 830001Urumqi, China
| | - Muzhi Chen
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318, Chaowang Road, Gongshu District, 310005Hangzhou, China
| |
Collapse
|
5
|
Mishra K, Kumar S, Ninawe S, Bahl R, Meshram A, Singh K, Jandial A, Sahu KK, Sandal R, Khera S, Yanamandra U, Khurana H, Kumar R, Kapoor R, Sharma S, Singh J, Das S, Ahuja A, Somasundaram V, Chaterjee T. The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings. Ther Adv Infect Dis 2021; 8:20499361211036592. [PMID: 34394928 PMCID: PMC8358573 DOI: 10.1177/20499361211036592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days (p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 (p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.
Collapse
Affiliation(s)
- Kundan Mishra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Suman Kumar
- DM (Clinical Hematology), Prof & Head of the Department, Department of Clinical Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010, India
| | - Sandeep Ninawe
- Department of Microbiology, Army Hospital (Research & Referral) Delhi, India
| | - Rajat Bahl
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Ashok Meshram
- Department of Internal Medicine, INHS Asvini, Mumbai, MH, India
| | - Kanwaljeet Singh
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Aditya Jandial
- Department of Internal Medicine, PGIMER, Chandigarh, CH, India
| | - Kamal Kant Sahu
- Hematology & Medical Oncology Fellow (PGY 4), Huntsman Cancer Institute, University of Utah, Salt Lake City, 84112, Utah, USA
| | - Rajeev Sandal
- Department of Radiotherapy and Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjeev Khera
- Department of Pediatrics, Army Hospital (Research & Referral) Delhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Harshit Khurana
- Department of Internal Medicine, Command Hospital (Air Force), Bangaluru, KA, India
| | - Rajiv Kumar
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Rajan Kapoor
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Sanjeevan Sharma
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Jasjit Singh
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Satyaranjan Das
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Ankur Ahuja
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Venkateshan Somasundaram
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Tathagat Chaterjee
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| |
Collapse
|