Presumed pseudobacteremia outbreak resulting from contamination of proportional disinfectant dispenser

Reported here are the microbiological and epidemiological details of a presumed outbreak of aerobic gram-negative bacilli infections affecting 19 hematological patients, which was traced to contaminated disinfectant. Over a 5-month period, the following organisms were isolated from the blood cultures of 19 neutropenic patients: Pseudomonas fluorescens (n = 13), Achromobacter xylosoxidans (n = 12), Comamonas testosteroni (n = 2) or Stenotrophomonas maltophilia (n = 1). The affected patients were all treated with an expensive regimen of broad-spectrum antibiotic therapy. The same bacteria were recovered from environmental samples as well as from the water pipes of an apparatus for dispensing disinfectant (didecyldimethylammonium chloride). Genotyping results indicated that many of the clinical strains were identical to strains isolated from the apparatus. It was eventually discovered that the night staff was in the habit of disinfecting the blood-culture bottles before use, thereby contaminating the bottles with bacteria contained in the disinfectant. Contamination of the apparatus resulted from faulty maintenance.

[Post-traumatic fracture and migration in the pulmonary artery of the catheter of a totally implantable venous access device. Unusual complication]

The case of a 59 year-old patient, who sustained a post-traumatic fracture of the silastic catheter of his totally implantable venous access device that migrated in the right pulmonary artery, is reported. The venous device was placed six months earlier for the treatment of metastatic spread of a primary unknown adenocarcinoma. The venous device was placed on the left side in consideration of a recent right supraclavicular node biopsy. The catheter was introduced through the left internal jugular vein and its peripheral end was positioned subcutaneously across the clavicle to be connected to the port chamber placed in the infraclavicular region. The accidental fracture of the catheter was attributed to a closed trauma occurred during the transport of a refrigerator on the homolateral shoulder. Treatment involved extraction of the migrated fragment through a percutaneous transfemoral angioradiological procedure. A few days later the chamber was removed and a new totally implantable venous access device was placed on the other side.

Phase I study of cinchonine, a multidrug resistance reversing agent, combined with the CHVP regimen in relapsed and refractory lymphoproliferative syndromes

Overexpression of P-glycoprotein (P-gp) in cancer cells reduces intracellular accumulation of various anticancer drugs including anthracyclines and vinca alkaloids. This multidrug resistance (MDR) phenotype can be reversed in vitro by a number of non-cytotoxic drugs. We have identified the quinine's isomer cinchonine as a potent MDR reversing agent, both in vitro and in animal models. Here, we report an open phase I dose escalation trial in patients with refractory or relapsed malignant lymphoid diseases. Cinchonine dihydrochloride was administered by continuous i.v. infusion for 48 h and escalated over five dose levels ranging from 15 to 35 mg/kg/d. Cinchonine infusion started 24 h before i.v. doxorubicin (25 mg/m2), vinblastine (6 mg/m2), cyclophosphamide (600 mg/m2) and methylprednisolone (1 mg/kg/d) (CHVP regimen) and lasted for 24 h after chemotherapy infusion. Thirty-four patients received 87 cycles of CHVP/cinchonine. The MTD of cinchonine administered by continuous i.v. infusion was 30 mg/kg/d. Prolonged cardiac repolarization was the main dose-limiting toxicity. No ventricular arrhythmia including 'torsade de pointes' was observed. An MDR reversing activity was identified in the serum from every patient and correlated with cinchonine serum level. When infused at 30 mg/kg/d, cinchonine demonstrated a limited influence on doxorubicin pharmacokinetic. We conclude that i.v. infusion of cinchonine might be started 12 h before MDR-related chemotherapy infusion and requires continuous cardiac monitoring but no reduction of cytotoxic drug doses.

Oxaliplatin, 5-fluorouracil, and folinic acid (Folfox) in patients with metastatic renal cell carcinoma: results of a pilot study

We report the results of a chemotherapy regimen combining oxaliplatin, 5-fluorouracil, and folinic acid in patients with metastatic renal cell carcinoma. The objective of this pilot study was to define the potential efficacy of this second-line combination in patients previously treated with interleukin-2 alone or in combination with interferon alpha. Fourteen patients with metastatic renal cell carcinoma in failure after immunotherapy were included in this trial. During treatment, patients received six chemotherapy courses (Folfox regimen) administered every 2 weeks. Each cycle combined oxaliplatin day (D) D1 and folinic acid plus 5-fluorouracil D1 and D2. At completion of treatment, no objective response was observed and two patients presented stable disease. This chemotherapy schedule in patients with metastatic renal cell carcinoma previously treated with immunotherapy does not seem to be effective.

[Prevention of chemotherapy-induced alopecia in cancer patients by scalp hypothermia (author's transl)]

Chemotherapy-induced alopecia observed in cancer patients can now be prevented by a simple, effective, inexpensive and well tolerated procedure: scalp hypothermia. Refrigeration is obtained by placing on the scalp two bags filled with crushed ice 15 minutes before, and removing them 15 minutes after intravenous injection of antineoplastic drugs. Only patients treated with drug combinations that are rapidly administered (into the giving-set tube or by i.v. infusion lasting less than 60 minutes) seem to benefit from scalp hypothermia. The fact that good results were obtained with those drugs (adriamycin, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine) and modes of administration that are most commonly used in women with breast cancer or ovarian cancer makes this procedure extremely interesting.

Effects of phenylbutazone on extravascular diffusion, protein binding and urinary excretion of cefazolin in rabbits

The effects of an anti-inflammatory drug, phenylbutazone, on the disposition of a commonly used cephalosporin, cefazolin, were studied in rabbits. The following investigations were made: mathematical analysis of blood levels obtained after i.v bolous injection of cefazolin, alone or combined with phenylbutazone (10 mg/kg), injection 4 hr before; protein binding by ultracentrifugation in vitro; and renal excretion and distribution in extravascular fluid obtained from s.c. tissue cages in vivo. Single i.m. injections of cefazolin (30 mg/kg) were administered either alone or in combination with phenylbutazone (10 or 100 mg/kg i.m.) or 2 or 4 hr before. The mathematical analysis disclosed a competition of phenylbutazone on protein binding of cefazolin. In vitro, phenylbutazone reduced the extent of protein binding of the antibiotic (74-80 to 47-59%). Cefazolin appeared at higher concentrations in extravascular fluid in the presence of phenylbutazone than when administered alone. Phenylbutazone appeared to be responsible for a dose-dependent effect on renal excretion of cefazolin i.e., a reduction of secretion at low doses (10 mg/kg) and a possible reduction of tubular reabsorption at high doses (100 mg/kg). A bidirectional transport of cefazolin in rabbit tubules was thus shown. The interaction of phenylbutazone on the on the disposition of cefazolin appeared also dependent on the time of injection of the former and on the mode of administration of the antibiotic.