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Barnbrock A, Salmanton-García J, Lankes F, Bochennek K, Schöning S, Lehrnbecher T. No Impact of Dietary Restrictions on the Risk for Infection in Pediatric Patients With Cancer: A Monocenter Analysis. JCO Oncol Pract 2024; 20:503-508. [PMID: 38261984 DOI: 10.1200/op.23.00553] [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: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
PURPOSE Prophylactic anti-infective strategies are used in patients with cancer to decrease the risk for infection. Dietary restrictions do not allow raw vegetables and fresh fruits to limit the introduction of potentially harmful pathogens in the gastrointestinal tract, but the efficacy is unclear. PATIENTS AND METHODS In this study analyzing the impact of the dietary restrictions on infectious complications, all children treated between April 2014 and March 2018 for ALL and AML or non-Hodgkin lymphoma (NHL) were included. Dietary restrictions were standard until March 2016, but were stopped in April 2016. Patients with dietary restrictions (treated April 2014-March 2016) and patients not advised for dietary restrictions (treated April 2016-March 2018) were compared regarding infectious complications, including bloodstream infection, pneumonia, diarrhea, and fever of unknown origin (FUO). RESULTS Eighty-six patients (25 female; 62 ALL; nine AML, 15 NHL) experienced 223 infections. The 46 patients with dietary restrictions and the 40 patients without food restrictions did not significantly differ regarding the number of infections per patient, bloodstream infections, pneumonia, diarrhea, FUO, admission to intensive care, and death. CONCLUSION Our data suggest that dietary restrictions do not affect the risk for infectious complications. Therefore, the indication of dietary restrictions should be reconsidered in pediatric patients with cancer.
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Affiliation(s)
- Anke Barnbrock
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Franziska Lankes
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Konrad Bochennek
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Stefan Schöning
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Thomas Lehrnbecher
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
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Groll AH, Ebrahimi-Fakhari D. Conference Report 33rd European Congress on Clinical Microbiology and Infectious Diseases (ECCMID): New developments in pediatric oncology infectious disease supportive care. Transpl Infect Dis 2023; 25:e14146. [PMID: 37695128 DOI: 10.1111/tid.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
Infections continue to be major causes of morbidity and mortality in immunocompromised children and adolescents with cancer or undergoing allogeneic hematopoietic cell transplantation. This report summarizes new clinical research data presented at the 33rd European Congress on Clinical Microbiology and Infectious Diseases on infections in this vulnerable population, with a focus on the epidemiology, diagnosis, and prevention of invasive fungal diseases and de-escalation strategies in neutropenic patients with fever of unknown origin.
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Affiliation(s)
- Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children´s Hospital Münster, Münster, Germany
| | - Daniel Ebrahimi-Fakhari
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children´s Hospital Münster, Münster, Germany
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Alarming Upward Trend in Multidrug-Resistant Bacteria in a Large Cohort of Immunocompromised Children: A Four-Year Comparative Study. Cancers (Basel) 2023; 15:cancers15030938. [PMID: 36765895 PMCID: PMC9913360 DOI: 10.3390/cancers15030938] [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: 01/02/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Documenting bacteremia at the onset of fever in immunosuppressed children is challenging; therefore, it leads to the early administration of broad-spectrum antibiotics. We aimed to analyse the evolution of antibiotic resistance profiles of bacterial bloodstream infections (BSI) and gut colonisations in a large cohort of immunocompromised children carrying a central venous catheter, in comparison with a prior, similar study conducted in our centre from 2014 to 2017. A retrospective, observational cohort study was conducted from January 2018 to December 2021, in a tertiary centre for paediatric immuno-haematology and oncology. Empirical antibiotic therapy was adapted to the immunosuppression risk group and prior bacterial colonisation. There was a mean of 6.9 BSI/1000 patient bed days. Multidrug-resistant bacteria (MDRB) associated BSI accounted for 35/273 (12.8%). The incidence of MDRB gum/gut colonisation and MDRB associated BSI increased annually and correlated with the level of immunosuppression (p = 0.024). One third (34.7%) of the BSI episodes were not associated with neutropenia. As compared to the previous study, an alarming emergence of MDRB responsible for gut colonisations and BSI in immunosuppressed children was reported over the last four years. The degree of immunosuppression directly correlates with the risk of having an MDRB gut colonisation or MDRB BSI.
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Hamada R, Sato S, Miyasaka J, Murao M, Matsushita M, Kajimoto T, Otagaki A, Asano T, Nankaku M, Kondo T, Arai Y, Kanda J, Takaori-Kondo A, Ikeguchi R, Matsuda S. Belt Electrode-Skeletal Muscle Electrical Stimulation During Early Hematopoietic Post-Transplantation To Prevent Skeletal Muscle Atrophy and Weakness. Transplant Cell Ther 2023; 29:51.e1-51.e7. [PMID: 36216251 DOI: 10.1016/j.jtct.2022.09.030] [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: 07/12/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
A decline in physical functions at the early stage of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a serious issue. Belt electrode-skeletal muscle electrical stimulation (B-SES) can induce significant muscle contractions with electrical stimulation and reduce muscle weakness. However, this approach has not been used in allo-HSCT patients. This study aimed to examine the effect of B-SES on physical function, and safety in patients during the early post-transplantation period. Forty-three adult patients who underwent B-SES after allo-HSCT were stratified into 2 groups based on the intensity of electrical stimulation (high versus low). B-SES was performed in combination with exercise therapy for 4 post-transplantation weeks. Knee extensor strength (KES) in the low B-SES group decreased significantly, whereas no change was observed in the high-intervention group. A significant positive correlation was observed between total intensity and ΔKES. A reduction in the 6-minute walking distance in the high B-SES group patients was lower than that of historical data. Two patients had B-SES-related complications including muscle pain. This study is the first to propose a new rehabilitation intervention strategy for allo-HSCT. Combined use of B-SES may be a new approach to reducing the decline of physical function in the early post-transplantation period.
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Affiliation(s)
- Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto 8507, Japan
| | - Junsuke Miyasaka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Michiko Matsushita
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Taishi Kajimoto
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Ayumi Otagaki
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Tsugumi Asano
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
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Krebs SK, Stech M, Jorde F, Rakotoarinoro N, Ramm F, Marinoff S, Bahrke S, Danielczyk A, Wüstenhagen DA, Kubick S. Synthesis of an Anti-CD7 Recombinant Immunotoxin Based on PE24 in CHO and E. coli Cell-Free Systems. Int J Mol Sci 2022; 23:ijms232213697. [PMID: 36430170 PMCID: PMC9697001 DOI: 10.3390/ijms232213697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Recombinant immunotoxins (RITs) are an effective class of agents for targeted therapy in cancer treatment. In this article, we demonstrate the straight-forward production and testing of an anti-CD7 RIT based on PE24 in a prokaryotic and a eukaryotic cell-free system. The prokaryotic cell-free system was derived from Escherichia coli BL21 StarTM (DE3) cells transformed with a plasmid encoding the chaperones groEL/groES. The eukaryotic cell-free system was prepared from Chinese hamster ovary (CHO) cells that leave intact endoplasmic reticulum-derived microsomes in the cell-free reaction mix from which the RIT was extracted. The investigated RIT was built by fusing an anti-CD7 single-chain variable fragment (scFv) with the toxin domain PE24, a shortened variant of Pseudomonas Exotoxin A. The RIT was produced in both cell-free systems and tested for antigen binding against CD7 and cell killing on CD7-positive Jurkat, HSB-2, and ALL-SIL cells. CD7-positive cells were effectively killed by the anti-CD7 scFv-PE24 RIT with an IC50 value of 15 pM to 40 pM for CHO and 42 pM to 156 pM for E. coli cell-free-produced RIT. CD7-negative Raji cells were unaffected by the RIT. Toxin and antibody domain alone did not show cytotoxic effects on either CD7-positive or CD7-negative cells. To our knowledge, this report describes the production of an active RIT in E. coli and CHO cell-free systems for the first time. We provide the proof-of-concept that cell-free protein synthesis allows for on-demand testing of antibody−toxin conjugate activity in a time-efficient workflow without cell lysis or purification required.
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Affiliation(s)
- Simon K. Krebs
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
- Institute for Biotechnology, Technical University of Berlin, Ackerstrasse 76, 13355 Berlin, Germany
| | - Marlitt Stech
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
| | - Felix Jorde
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
| | - Nathanaël Rakotoarinoro
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
- Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Strasse 2 + 4, 14195 Berlin, Germany
| | - Franziska Ramm
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 6, 14195 Berlin, Germany
| | - Sophie Marinoff
- Glycotope GmbH, Robert-Roessle-Strasse 10, 13125 Berlin, Germany
| | - Sven Bahrke
- Glycotope GmbH, Robert-Roessle-Strasse 10, 13125 Berlin, Germany
| | - Antje Danielczyk
- Glycotope GmbH, Robert-Roessle-Strasse 10, 13125 Berlin, Germany
| | - Doreen A. Wüstenhagen
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
| | - Stefan Kubick
- Branch Bioanalytics and Bioprocesses (IZI-BB), Fraunhofer Institute for Cell Therapy and Immunology (IZI), Am Mühlenberg 13, 14476 Potsdam, Germany
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 6, 14195 Berlin, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, 14476 Potsdam, Germany
- Correspondence:
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Evaluation of Possible Effects of the COVID-19 Pandemic on Febrile Neutropenia Episodes in Children With Acute Leukemia. J Pediatr Hematol Oncol 2022; 44:e976-e981. [PMID: 34654763 DOI: 10.1097/mph.0000000000002348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/11/2021] [Indexed: 11/26/2022]
Abstract
With the rapid spread of coronavirus disease 2019 (COVID-19) around the globe, concerns about the management of patients with malignancy have risen significantly. This study aimed to investigate the possible impact of the COVID-19 pandemic and prevention policies on the incidence and etiology of febrile neutropenia (FN) episodes in children with acute leukemia. Children who had acute leukemia and were diagnosed as FN in a tertiary center from March 2018 to March 2021 were included in the study. FN episodes were grouped as prepandemic and postpandemic based on the date that pandemic was declared. Relevant data were collected retrospectively. We evaluated 113 FN episodes (75.2% were prepandemic) of 46 patients, a median of 4.7 (2.6 to 12.6) years of age. The number of FN episodes per patient did not differ between prepandemic and postpandemic periods ( P =0.476). There was no significant difference among the 2 groups regarding the microbiologic causes, focus of fever, and clinical outcomes in FN episodes. Two of the patients were diagnosed as COVID-19 and recovered without any complications. In conclusion, we showed that the incidence and etiology of FN episodes were similar before and during the COVID-19 pandemic in children with acute leukemia.
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7
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Hamada R, Asano T, Murao M, Miyasaka J, Matsushita M, Kajimoto T, Otagaki A, Nankaku M, Arai Y, Kanda J, Kondo T, Takaori-Kondo A, Ikeguchi R, Matsuda S. Intramuscular Adipose Tissue Content Predicts Patient Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2022; 28:602.e1-602.e7. [DOI: 10.1016/j.jtct.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
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8
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Lavieri L, Koenig C, Bodmer N, Agyeman PKA, Scheinemann K, Ansari M, Roessler J, Ammann RA. Predicting fever in neutropenia with safety-relevant events in children undergoing chemotherapy for cancer: The prospective multicenter SPOG 2015 FN Definition Study. Pediatr Blood Cancer 2021; 68:e29253. [PMID: 34310027 DOI: 10.1002/pbc.29253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fever in neutropenia (FN) remains a frequent complication in pediatric patients undergoing chemotherapy for cancer. Preventive strategies, like primary antibiotic prophylaxis, need to be evidence-based. PROCEDURE Data on pediatric patients with any malignancy from the prospective multicenter SPOG 2015 FN Definition Study (NCT02324231) were analyzed. A score predicting the risk to develop FN with safety-relevant events (SRE; bacteremia, severe sepsis, intensive care unit admission, death) was developed using multivariate mixed Poisson regression. Its predictive performance was assessed by internal cross-validation and compared with the performance of published rules. RESULTS In 238 patients, 318 FN episodes were recorded, including 53 (17%) with bacteremia and 68 (21%) with SRE. The risk-prediction score used three variables: chemotherapy intensity, defined according to the expected duration of severe neutropenia, time since diagnosis, and type of malignancy. Its cross-validated performance, assessed by the time needed to cover (TNC) one event, exceeded the performance of published rules. A clinically useful score threshold of ≥11 resulted in 2.3% time at risk and 4.1 months TNC. Using external information on efficacy and timing of intermittent antibiotic prophylaxis, 4.3 months of prophylaxis were needed to prevent one FN with bacteremia, and 5.2 months to prevent one FN with SRE, using a threshold of ≥11. CONCLUSIONS This score, based on three routinely accessible characteristics, accurately identifies pediatric patients at risk to develop FN with SRE during chemotherapy. The score can help to design clinical decision rules on targeted primary antibiotic prophylaxis and corresponding efficacy studies.
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Affiliation(s)
- Luana Lavieri
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Bodmer
- Pediatric Oncology, University Children's Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katrin Scheinemann
- Pediatric Hematology/Oncology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland.,University of Basel, Basel, Switzerland.,Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Marc Ansari
- Pediatric Hematology/Oncology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland.,Department of Pediatrics, Gynecology, and Obstetrics, Cansearch Research Platform of Pediatric Oncology and Hematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland A Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
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Kim JG, Park Y, Lee J, Ju JH, Kim WU, Park SH, Kwok SK. Re-evaluation of the prognostic significance of oropharyngeal dysphagia in idiopathic inflammatory myopathies. Scand J Rheumatol 2021; 51:402-410. [PMID: 34470549 DOI: 10.1080/03009742.2021.1941243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the prognostic significance of videofluorographic swallowing study (VFSS)-confirmed oropharyngeal dysphagia in idiopathic inflammatory myopathies (IIMs). METHOD We reviewed the medical records of patients who were diagnosed with IIM between 2009 and 2020 at Seoul St Mary's Hospital. All oropharyngeal dysphagia cases were limited to VFSS-confirmed dysphagia found during the initial diagnostic work-up for IIM. We described the findings on VFSS and the course of the dysphagic symptoms. Logistic regression and survival analyses were performed to evaluate the risk of pneumonia and mortality, respectively. RESULTS We found 88 patients with IIM who met the criteria. Among them, 17 patients (19%) had oropharyngeal dysphagia. Except for two cases lost to follow-up and one deceased case, all of the patients with dysphagia (14 of 14) had swallowing function restored within 6 months. The risk of pneumonia within 3 months from the diagnosis of IIM was significant [odds ratio = 4.49, 95% confidence interval (CI) 1.07-18.88]. The median follow-up duration was 34 and 27 months for the groups without and with dysphagia, respectively. The survival analysis failed to demonstrate that the presence of oropharyngeal dysphagia increased the risk of death (hazard ratio = 0.77, 95% CI: 0.085-7.00). CONCLUSIONS Oropharyngeal dysphagia found at the initial diagnosis of IIM improved within 3-6 months in nearly all cases. Furthermore, IIM patients who had oropharyngeal dysphagia at the initial diagnosis of IIM were not likely to have shorter survival, even if the risk of pneumonia was increased in the short term.
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Affiliation(s)
- J G Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - J Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - J H Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - W-U Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S-K Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Ockfen S, Egle L, Sauter K, Haber M, Becker SL, Wagenpfeil G, Graf N, Simon A. Meropenem Use in Pediatric Oncology - Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data. KLINISCHE PADIATRIE 2021; 233:278-285. [PMID: 34261135 DOI: 10.1055/a-1481-8905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meropenem is an important second- or third-line antibiotic in pediatric cancer patients with febrile neutropenia (FN). Concise utilization data of meropenem in this setting is limited. It remains unclear how drug dispensing data from the hospital pharmacy correlate with data derived from patients' files. METHODS Retrospective audit of meropenem-consumption in a University-affiliated pediatric oncology center in days of therapy (DOT)/100 inpatient days. The individual indication for meropenem was critically reviewed. The real consumption (in g/100 inpatient days) was compared with the drug amounts dispensed by the hospital pharmacy (in gram and in defined daily doses (DDD)/100 inpatient days). All patients receiving at least one dose of meropenem from 1st of April 2016 until the 30th of June 2018 were included. RESULT Of 235 consecutive patients, 45 (19%) received meropenem, comprising 57 FN events. The probability of receiving at least one dose of meropenem was significantly higher in patients with ALL, AML, NHL and certain CNS tumors. Preceding the use of meropenem, only 5% of patients were known to be colonized with multidrug-resistant Gram-negative pathogens. Meropenem was administered as first-line treatment in 26% of all meropenem cycles, in 74% of all FN events with meropenem, Piperacillin-Tazobactam was used for initial treatment. In 5 of 57 FN events (8.8%), initial blood cultures yielded a Gram-negative pathogen. Concerning definite treatment, appropriate alternatives to meropenem with a smaller spectrum of activity would have been available in 4 cases, but a de-escalation was not performed. The median length of therapy in the meropenem group was 6 days, the corresponding median for days of therapy (DOT) was 12 days. This corresponds with combination therapy in 56% of all meropenem treatments, mostly with teicoplanin. On average, drug dispensing data from the hospital pharmacy were 1.53 times higher than real use (relying on patients' data) without a significant correlation. A higher Case-mix Index positively correlated with meropenem-consumption. CONCLUSION The use of meropenem should become a target of antibiotic stewardship programs in order to restrict its use to certain indications and preserve its outstanding role as second- or third-line antibiotic in this vulnerable population. Irrespective of the metrics used (g or DDD/100 inpatient days), pharmacy dispensing data do not accurately depict real patient-derived data concerning meropenem use in pediatric cancer patients.
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Affiliation(s)
- Svenja Ockfen
- Pediatric Hematology and Oncology, Children's Hospital Medical Center, Children's Hospital Medical Center, Saarland University Hospital, Homburg, Germany
| | - Leonie Egle
- Pediatric Hematology and Oncology, Children's Hospital Medical Center, Children's Hospital Medical Center, Saarland University Hospital, Homburg, Germany
| | - Katharina Sauter
- Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
| | - Manfred Haber
- Director Hospital Pharmacy, Saarland University Hospital, Homburg/Saar, Homburg, Germany
| | - Sören L Becker
- Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
| | - Gudrun Wagenpfeil
- Saarland University, Campus Homburg, Institutes for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Homburg, Germany
| | - Norbert Graf
- Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
| | - Arne Simon
- Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
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11
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Springer J, Held J, Mengoli C, Schlegel PG, Gamon F, Träger J, Kurzai O, Einsele H, Loeffler J, Eyrich M. Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation. J Fungi (Basel) 2021; 7:jof7030238. [PMID: 33810069 PMCID: PMC8004996 DOI: 10.3390/jof7030238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
- Correspondence: ; Tel.: +49-931-201-36404; Fax: +49-931-201-36409
| | - Jürgen Held
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Carlo Mengoli
- Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, 35122 Padua, Italy;
| | - Paul Gerhardt Schlegel
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
| | - Florian Gamon
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Johannes Träger
- Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany; (J.H.); (J.T.)
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, 07745 Jena, Germany;
- Institute for Hygiene and Microbiology, University Würzburg, 97080 Würzburg, Germany
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Juergen Loeffler
- Department for Internal Medicine II, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.G.); (H.E.); (J.L.)
| | - Matthias Eyrich
- Kinderklinik und Poliklinik, University Medical Center Würzburg, 97080 Würzburg, Germany; (P.G.S.); (M.E.)
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12
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Simon A, Siebald B, Stamm W, Graf N, Meier S, Schrappe M, Groll AH, Laws HJ, Lehrnbecher T. School and kindergarten attendance and home schooling of pediatric cancer patients before and during the SARS-CoV-2 pandemic: results of a survey of the German Society for Pediatric Oncology and Hematology. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc10. [PMID: 33796438 PMCID: PMC7982994 DOI: 10.3205/dgkh000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this multicenter survey (July 07 to August 08, 2020) in pediatric oncology centers (POCs) belonging to the German Society for Pediatric Oncology and Hematology (GPOH), 36 POCs participated (response rate 70.6%). Home schooling practice was judged as satisfying by 79% prior to and by 38% during the pandemic (P=0.0007). The individual risk of a SARS-CoV-2 infection and the risk of transmission to other patients/caregivers were arguments against attendance. Most POCs recommended regular social participation/school attendance after the end of intensive therapy. 81% stated that persisting restrictions result in serious negative psychosocial consequences for the patients and their families. In-hospital school education, home schooling and re-attendance of school and kindergarten among pediatric cancer patients have suffered a severe setback during the SARS-CoV-2 pandemic. Continuous communication and education concerning protective measures as well as an individual risk assessment are required to avoid the detrimental exclusion of pediatric oncology patients from kindergarten and school.
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Affiliation(s)
- Arne Simon
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, University Clinics, Homburg, Germany
| | - Benjamin Siebald
- Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Walther Stamm
- Department of Pediatrics and Children’s Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing, Munich, Germany
| | - Norbert Graf
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, University Clinics, Homburg, Germany
| | - Stephan Meier
- Rehabilitation Center for Pediatric Hematology and Oncology Katharinenhöhe gGmbH, Schönwald, Germany
| | - Martin Schrappe
- Pediatrics I, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children’s Hospital, Münster, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Lehrnbecher
- Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
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Cooksley T, Font C, Scotte F, Escalante C, Johnson L, Anderson R, Rapoport B. Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper. Support Care Cancer 2020; 29:1129-1138. [PMID: 33230644 PMCID: PMC7682766 DOI: 10.1007/s00520-020-05906-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities. Cancer patients testing positive with no or minimal symptoms may be monitored from home. Telemedicine is an option to aid in following patients without potential exposure. Management of complications of systemic anticancer treatment, such as febrile neutropenia (FN), is of particular importance during the COVID-19 pandemic where clinicians aim to minimize patients' risk of infection and need for hospital visits. Outpatient management of patients with low-risk FN is a safe and effective strategy. Although the MASCC score has not been validated in patients with suspected or confirmed SARS-CoV-2, it has nevertheless performed well in patients with a range of infective illnesses and, accordingly, it is reasonable to expect efficacy in the clinical setting of COVID-19. Risk stratification of patients presenting with FN is a vital tenet of the evolving sepsis and pandemic strategy, necessitating access to locally formulated services based on MASCC and other national and international guidelines. Innovative oncology services will need to utilize telemedicine, hospital at home, and ambulatory care services approaches not only to limit the number of hospital visits but also to anticipate the complications of the anticancer treatments.
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Affiliation(s)
- Tim Cooksley
- Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK.
| | - Carme Font
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Florian Scotte
- Interdisciplinary Cancer Course Department (DIOPP), Gustave Roussy Cancer Institute, Villejuif, France
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14
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Lu X, Tang LV, Wang HF, You Y, Wang YD, Hu Y, Shi W, Xia LH. The great challenge of managing recipients of hematopoietic stem cell transplantation combined with COVID-19. Bone Marrow Transplant 2020; 56:696-700. [PMID: 32843727 PMCID: PMC7446604 DOI: 10.1038/s41409-020-01035-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Xuan Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Fang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong You
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Dan Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Shi
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Ling-Hui Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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