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Arnhold APC, Araújo HGS, Cruz AF, Toffolo MCF, Mauricio SF. Use of neutropenic diet in the nutritional care of pediatric cancer patients with neutropenia: a scoping review. J Pediatr (Rio J) 2024; 100:132-142. [PMID: 37813344 PMCID: PMC10943308 DOI: 10.1016/j.jped.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. SOURCE OF DATA The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. SUMMARY OF THE FINDINGS Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. CONCLUSION In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.
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Affiliation(s)
| | | | - Ana Facury Cruz
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte, MG, Brazil
| | | | - Silvia Fernandes Mauricio
- Universidade Federal de Ouro Preto, Departamento de Nutrição Clínica e Social, Ouro Preto, MG, Brazil.
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Celebı D, Celebı O, Aydin E, Baser S, Güler MC, Yildirim S, Taghizadehghalehjoughi A. Boron Compound-Based Treatments Against Multidrug-Resistant Bacterial Infections in Lung Cancer In Vitro Model. Biol Trace Elem Res 2024; 202:145-160. [PMID: 37884681 DOI: 10.1007/s12011-023-03912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
Multidrug-resistant bacteria is one of the most important public health problems. Increasing rates of antibacterial resistance also affect the outcomes of medical approaches. Cancer treatment because of immune system deficiency (chemotherapy or steroids usage) commonly can cause infection. Lung cancer is the dominant cause of cancer-related deaths, and infection is the most common cause of death among those patients. In this study, it was aimed to determine the antimicrobial, antibiofilm, and anticancer activity of boron compounds. A549 lung cancer cell line was infected with Acinetobacter baumannii (ATCC 19606), Klebsiella pneumoniae (ATCC 700603), and Pseudomonas aeruginosa (ATCC 27853). In order to determine the fractional inhibitory concentration (FIC) index, antibiotics and boron compound concentrations prepared according to the minimum inhibitory concentration (MIC) values were determined by the checkerboard method. In our study results, the antibiofilm activity was an average of 46% in A. baumannii+boron compounds, 45% in P. aeruginosa+boron compounds, and 43% in K. pneumoniae. Cell culture analysis results show a decrease in viability and antioxidant capacity and an increase in total oxidant status after adding boron compounds to the culture. Immunofluorescence results show a correlation with MTT, and boron compounds increased 8-OHdG expression in comparison to antibiotic administration. In conclusion, boron compounds have promising effects on bacteria, especially in resistant bacteria spp.
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Affiliation(s)
- Demet Celebı
- Department of Microbiology, Faculty of Veterinary Medicine, Ataturk University, 25240, Erzurum, Turkey.
- Ataturk University Vaccine Application and Development Center, Ataturk University, 25240, Erzurum, Turkey.
| | - Ozgur Celebı
- Department of Medical Microbiology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Elif Aydin
- Vocational School of Health Services, Kütahya Health Sciences University, Kütahya, Turkey
| | - Sumeyye Baser
- Department of Medical Microbiology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Mustafa Can Güler
- Department of Medical Physiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Serkan Yildirim
- Department of Pathology, Faculty of Veterinary Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Ali Taghizadehghalehjoughi
- Department of Medical Pharmacology, Faculty of Medicine, Seyh Edebali University, 11000, Bilecik, Turkey
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Roy Moulik N, Keerthivasagam S, Velagala SV, Gollamudi VRM, Agiwale J, Dhamne C, Chichra A, Srinivasan S, Shetty D, Jain H, Subramanian PG, Tembhare P, Chatterjee G, Patkar N, Narula G, Banavali S. Treating relapsed B cell-precursor ALL in children with a setting-adapted mitoxantrone-based intensive chemotherapy protocol (TMH rALL-18 PROTOCOL) - experience from Tata Memorial Hospital, India. Ann Hematol 2023; 102:2835-2844. [PMID: 37479890 DOI: 10.1007/s00277-023-05351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
The outlook of relapsed ALL in low- and middle-income countries (LMICs) is dismal due to high treatment-related toxicities and inadequate resources. We report our experience of using a locally adapted mitoxantrone-based protocol for non-high risk (HR) relapsed B-ALL (rALL). A retrospective cum prospective study of standard and intermediate risk (SR and IR) rALL patients treated on TMH rALL-18 protocol (adapted from COG/UKALLR3/Int-Re-ALL protocols) between November 2018 and January 2021 was analyzed. The protocol comprising of 7 blocks of multi-agent chemotherapy including mitoxantrone in induction followed by local irradiation and maintenance, underwent serial modifications based on our experience with initial patients. Eighty-two patients (SR rALL, 3; IR rALL, 79) were treated on TMH rALL-18 protocol. Of 321 grade 3/4 reported toxicities, around 43% (138 toxicities) were noted during induction. Induction chemotherapy was outpatient-based; however, 68 patients (82.9%) required supportive care admissions. Twelve out of 19 patients with gram negative bacilli sepsis (included 7 MDRO) died during reinduction. Five remission deaths were seen during block 3 after which cytarabine was dose reduced (3 g to 2 g/m2). Post-reinduction minimal residual disease was negative in 54 (80.6%) out of 67 evaluable patients. At a median follow-up of 24 months (95% CI 22-27), the estimated 2-year event-free and overall survival of the entire cohort was 58% (95% CI 48.1-69.9) and 60.3% (95% CI 50.5-72). Until the time, targeted therapies are freely accessible in LMICs, strengthening supportive care as well as local adaptation of protocols that strike a fine balance between efficacy and tolerability are mandated.
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Affiliation(s)
| | | | | | | | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | - Dhanlaxmi Shetty
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Hemani Jain
- Cancer Cytogenetics, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | | | | | - Nikhil Patkar
- Hematopathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Joslyn D, Saber DA, Miles P. Predictors of Central Vascular Access Device Bloodstream Infections in Patients With Acute Leukemia and Neutropenia: A Retrospective Case-Control Chart Review. JOURNAL OF INFUSION NURSING 2023; 46:139-148. [PMID: 37104689 DOI: 10.1097/nan.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Central vascular access devices (CVADs) are standard for the treatment of leukemia. The objectives of this study were to examine predictors for central line-associated bloodstream infection (CLABSI) and causative microorganisms. A retrospective case/control design was used to examine electronic health records (EHRs) of patients with acute leukemia, a CVAD, and neutropenia. Variables were examined for differences between those who developed bacteremia (cases: n = 10) and those who did not (controls: n = 13). Variables included conditions of health (eg, patient history, laboratory results at the time of nadir, nutritional intake during hospitalization, and CVAD care practices). Fisher exact and Mann-Whitney U tests were used for comparison. Nine organisms were identified, including viridans group streptococci (20%) and Escherichia coli (20%). No statistical differences in variables were found between groups. However, over 50% of the nutritional intake data was missing due to lack of documentation. These findings indicate that further study is needed to examine barriers for electronic documentation. The data collection site found opportunities to improve patient care that included education regarding the daily care of CVADs, collaboration with nutritional services to ensure accurate assessments, and coordination with clinical information systems to improve clinical documentation compliance.
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Affiliation(s)
- Delight Joslyn
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
| | - Deborah A Saber
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
| | - Patricia Miles
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
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Factors associated with mortality from gram-negative bacterial infections in children with cancer. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2023. [DOI: 10.1016/j.phoj.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Nanayakkara AK, Boucher HW, Fowler VG, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin 2021; 71:488-504. [PMID: 34546590 DOI: 10.3322/caac.21697] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those with cancer.
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Affiliation(s)
- Amila K Nanayakkara
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amanda Jezek
- Infectious Diseases Society of America, Arlington, Virginia
| | - Kevin Outterson
- CARB-X, Boston, Massachusetts
- Boston University School of Law, Boston, Massachusetts
| | - David E Greenberg
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
- Department of Microbiology, University of Texas Southwestern, Dallas, Texas
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Silva RAM, de Mendonça RMH, Dos Santos Aguiar S, Yajima JC, Marson FAL, Brandalise SR, Levy CE. Induction therapy for acute lymphoblastic leukemia: incidence and risk factors for bloodstream infections. Support Care Cancer 2021; 30:695-702. [PMID: 34363492 DOI: 10.1007/s00520-021-06471-8] [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: 02/21/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Among the treatment-related acute toxic effects, risks for bloodstream infections (BSIs) are associated with several variables. The authors carried out a retrospective cohort study with 259 children and adolescents with ALL, treated with the GBTLI-LLA 2009 protocol, in order to assess the incidence of BSIs in the induction phase; to determine the risk factors for these BSIs; and to identify the related microorganisms and sensitivity profile of the microorganisms related to these infections. BSIs were documented in 19.3% of patients. The isolated microorganisms were 39 Gram-negative bacteria, 21 Gram-positive bacteria, and four fungi. There was a statistically significant risk of BSI between the variables: protocol for T-line-derived leukemia (Derived T Protocol) (p = 0.020), oral manifestations (p = 0.015), central venous catheter (p = 0.008), and bladder catheter (p = 0.004). BSI is a frequent event in ALL patients during the induction phase. The identification of these factors can allow the elaboration and improvement of strategies for the intensification of supportive care, prevention, and rapid treatment of infections.
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Affiliation(s)
- Rosângela Aparecida Mendes Silva
- Microbiology Laboratory, Centro Infantil Boldrini, Rua Gabriel Porto, 1270, Campinas, SP, 13083-210, Brazil.
- Pediatric Research Center, Campinas, State University of Campinas, Campinas, SP, Brazil.
| | - Regina Maria Holanda de Mendonça
- Pediatric Research Center, Campinas, State University of Campinas, Campinas, SP, Brazil
- Dentistry Unit, Centro Infantil Boldrini, Campinas, SP, Brazil
| | | | | | | | | | - Carlos Emílio Levy
- Department of Clinical Pathology, State University of Campinas, Campinas, SP, Brazil
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