colistin and Fever

Aztreonam (Az), a minimally absorbable monobactam antibiotic, was compared to colistin plus neomycin (CN), for intestinal decontamination during Bone Marrow Transplantation (BMT) in a controlled study. Thirty-four consecutive patients were randomized in two groups and evaluated for number of febrile episodes, days of fever, fecal cultures and clinical symptoms related to infections or colonizations. No significant differences were observed suggesting that Az is at least as effective as the CN regimen and may be considered as an alternative approach for intestinal decontamination in BMT patients.

Topics: Aztreonam; Bone Marrow Transplantation; Colistin; Digestive System Diseases; Drug Therapy, Combination; Feces; Fever; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Neomycin; Risk Factors; Time Factors

Recent meta-analyses showed that antibiotic prophylaxis in patients with neutropenia after chemotherapy reduced the incidence of fever and mortality rate. Fluoroquinolones appear to be most effective and well tolerated. Thus, in April 2008, we changed our antibiotic prophylaxis regimen from cotrimoxazole/colistin (COT/COL) to the fluoroquinolone ciprofloxacin (CIP) in patients with acute myeloid leukemia (AML). The aim of this retrospective study was to compare efficacy and development of bacterial resistance with two different prophylaxis regimens over a time period of more than 4 years.. Induction chemotherapy courses given for AML during the antibiotic prophylaxis period with COT/COL (01/2006-04/2008) and CIP (04/2008-06/2010) were retrospectively analyzed with a standard questionnaire.. Eighty-five courses in the COT/COL group and 105 in the CIP group were analyzed. The incidence of fever was not significantly different (COT/COL 80 % vs CIP 77 %; p = 0.724). Also, the rate of microbiologically documented infections was nearly the same (29 vs 26 %; p = 0.625). In addition, there was no significant difference in the incidence of clinically documented infections (11 vs 19 %; p = 0.155) or in the rates of detected gram-positive and gram-negative bacteria. Of note, there was no increase in resistance rates or cases with Clostridium difficile-associated diarrhea in the CIP group.. The antibiotic prophylaxis with CIP compared to COT/COL in AML was similarly effective with no increase in bacterial resistance. COT/COL may have the advantages of providing additional prophylaxis against Pneumocystis jirovecii pneumonia and leaving fluoroquinolones as an additional option for treatment of febrile neutropenia.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents; Bacterial Infections; Ciprofloxacin; Clostridioides difficile; Colistin; Diarrhea; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Female; Fever; Fluoroquinolones; Humans; Incidence; Leukemia, Myeloid, Acute; Male; Middle Aged; Neutropenia; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

We sought to approach a practical question: Should polymyxins be used in the initial empirical antibiotic regimen in the intensive care unit (ICU) patient with fever that is thought to be due to infection? By retrieving data from the literature and the WHONET Greece, we formulated a mathematical model to estimate the probability (Ptotal) that a gram-negative bacterium susceptible only to polymyxins is isolated from an ICU patient. Ptotal = P1 * P2 * P3 * P4, where Ptotal = total probability; P1 = probability that fever is due to infection; P2 = probability that infection is due to gram-negative bacteria; P3 = probability that the gram-negative bacterium is Acinetobacter baumannii, Pseudomonas aeruginosa, or Klebsiella pneumoniae; and P4 = probability that A. baumannii, P. aeruginosa, or K. pneumoniae is susceptible only to polymyxins. Using the information from our data sources, we estimated that P1 (before physician input in differential diagnosis) = 0.5, P2 = 0.523, P3 = 0.79, and P4 = 0.567, thus Ptotal = P1 * P2 * P3 * P4 = 0.5 * 0.523 * 0.79 * 0.567 = 0.117 = 11.7%. Based on this information and combining it with data regarding the attributable mortality of inappropriate empirical antimicrobial treatment, 4 to 5 patients in every 100 ICU patients will die if physicians do not include polymyxins in the initial empirical regimen in the ICU setting for an episode of fever due to infection. Polymyxins should probably be included in the empirical antibiotic regimen in the ICU setting in hospitals, where the observed probability that a gram-negative bacterium (A. baumannii, P. aeruginosa, or K. pneumoniae) is polymyxin-only-susceptible is close to that (50%) used in our model (based on the individual hospital data).

Topics: Anti-Bacterial Agents; Bacterial Infections; Colistin; Critical Care; Critical Illness; Decision Support Techniques; Fever; Gram-Negative Bacteria; Humans; Polymyxin B; Polymyxins; Probability; Sensitivity and Specificity; Shock

Topics: Agranulocytosis; Amikacin; Colistin; Drug Therapy, Combination; Fever; Humans; Kanamycin; Neutropenia; Sulfamethoxazole; Trimethoprim

Topics: Ampicillin; Child, Preschool; Chloramphenicol; Colistin; Diagnosis, Differential; Drug Eruptions; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Electroencephalography; Erythromycin; Female; Fever; Humans; Hydrocortisone; Infections; Kanamycin; Kidney Diseases; Male; Middle Aged; Penicillins; Pericarditis; Pertussis Vaccine; Pleural Diseases; Recurrence; Salicylates; Tetracycline; Tonsillectomy

Topics: Bacteria; Carbenicillin; Cephalothin; Colistin; Drug Combinations; Escherichia coli; Fever; Gentamicins; Humans; Immunosuppressive Agents; Infections; Kanamycin; Klebsiella; Methicillin; Neoplasms; Polymyxins; Proteus; Pseudomonas aeruginosa

Topics: Adolescent; Adult; Age Factors; Aged; Colistin; Cross Infection; Escherichia coli Infections; Female; Fever; Humans; Kanamycin; Klebsiella Infections; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Nitrogen; Penicillins; Proteus Infections; Pseudomonas Infections; Retrospective Studies; Sepsis; Sex Factors; Shock; Uremia

Topics: Albuminuria; Colistin; Eczema; Edema; Fever; gamma-Globulins; Humans; Infant; Kanamycin; Kaposi Varicelliform Eruption; Male; Neurologic Manifestations; Oxacillin; Smallpox Vaccine; Staphylococcal Infections; Thiosemicarbazones; Vaccinia virus

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Colistin; Cystoscopy; Fever; Humans; Infection Control; Kanamycin; Male; Methods; Middle Aged; Nalidixic Acid; Nitrofurantoin; Penicillin G; Penicillin Resistance; Postoperative Complications; Preoperative Care; Prostatectomy; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections; Urine

Topics: Animals; Brain; Chloramphenicol; Colistin; Electrocardiography; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukocyte Count; Meningitis; Penicillins; Sepsis; Snakes; Spinal Puncture; Streptomycin; Sulfadiazine