colistin and Leukemia

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Animals; Antibodies, Bacterial; Antineoplastic Agents; Arthritis, Infectious; Bone Diseases; Burns; Carbenicillin; Carrier State; Colistin; Cross Infection; Cystic Fibrosis; Disease Models, Animal; Drug Therapy, Combination; Gentamicins; Humans; Immunologic Deficiency Syndromes; Leukemia; Lung Diseases; Pneumonia; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Therapy; Skin Diseases, Infectious; Surgical Wound Infection; Transplantation, Homologous

In a randomized study comparing cotrimoxazole plus colistin with ciprofloxacin, each in combination with nonabsorbable antimycotics, the incidence of major infections in terms of septicemias and pneumonias as well as of minor infections and episodes of unexplained fever (FUO) was higher in patients treated with ciprofloxacin. In cases of microbiologically documented infections, gram-positive cocci dominated by far. In surveillance cultures of oral washings and of feces, gram-negative enterobacteria were only rarely detected; however, large numbers of cultures were positive for Acinetobacter species. There were four cases of documented Pneumocystis carinii pneumonia in patients not receiving cotrimoxazole. The incidence of documented mycotic infections as well as the detection of fungi in surveillance cultures was similar in both treatment groups. A decrease in the number of adverse events, especially of allergic reactions, could not be achieved by the administration of ciprofloxacin. In conclusion, cotrimoxazole plus colistin in combination with nonabsorbable antimycotics remains the standard regimen for prevention of infection in patients with acute leukemia undergoing aggressive remission induction therapy. A detailed analysis of study II will be prepared for publication.

Topics: Acute Disease; Anti-Bacterial Agents; Ciprofloxacin; Colistin; Drug Therapy, Combination; Humans; Infection Control; Infections; Leukemia; Multicenter Studies as Topic; Neutropenia; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

Pipemidic acid (PPA) and colistin sodium methanesulfonate (CLM) may selectively suppress aerobic gram-negative bacilli. Twenty-nine patients with acute leukemia were randomized after each course of consolidation chemotherapy to receive a single agent of nystatin (NYS) (34 courses) versus a combination of NYS, PPA and CLM (36 courses). The duration of fever over 39 degrees C was longer with the three drug combination (4.6 +/- 5.1 days) than with NYS alone (1.8 +/- 1.8 days) (P less than 0.01). Four cases of pneumonia occurred and four patients including one having pneumonia died of infection with the three drug combination, while no pneumonia or death occurred with NYS alone (P = 0.06 and P = 0.06, respectively). The combination of NYS, PPA and CLM may be less effective than NYS alone for the prevention of infection in acute leukemia patients with chemotherapy-associated granulocytopenia.

Topics: Acute Disease; Adolescent; Adult; Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Colistin; Drug Therapy, Combination; Gram-Negative Bacteria; Humans; Leukemia; Middle Aged; Nicotinic Acids; Nystatin; Pipemidic Acid; Pneumonia; Random Allocation

Norfloxacin has been compared to placebo (136 patients), sulfamethoxazole plus trimethoprim (SXT, 72 patients) and oral vancomycin plus colistin (V/C, 61 patients) for the prevention of alimentary tract-associated infections during and after induction chemotherapy. These patients were evaluated for the safety and tolerability of each regimen by clinical and laboratory means. Most neutropenics involved, regardless of the regimen, experienced at least one adverse experience. The majority were felt to be unrelated to prophylactic study drug therapy. Of 139 patients who received norfloxacin, only two had drug-related adverse experiences, compared to two of 35 receiving SXT, five of 28 for VC, and none of 67 receiving placebo. In evaluating adverse experiences considered possibly drug related, 19 occurred on norfloxacin compared to 13 for placebo. Among neurologic adverse experiences, only one possibly related to norfloxacin occurred (confusion), while three occurred on placebo (confusion, decreased auditory acuity and hallucinations). Generally, no significant differences were seen between any of the regimens except for a higher frequency of diarrhea in those receiving V/C.

Topics: Agranulocytosis; Bacterial Infections; Clinical Trials as Topic; Colistin; Diarrhea; Gastrointestinal Diseases; Humans; Leukemia; Neutropenia; Norfloxacin; Skin Diseases; Sulfamethoxazole; Trimethoprim; Vancomycin

Topics: Acute Disease; Adult; Anti-Infective Agents; Ciprofloxacin; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Humans; Infection Control; Leukemia; Neomycin; Neutropenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Ciprofloxacin, a new quinolone derivative, was given prophylactically (500 mg twice daily) to 15 patients with acute leukemia during remission induction treatment. The effect on the microbial flora of the alimentary tract was evaluated. A rapid elimination of Enterobacteriaceae was observed. Bacteriodes and Clostridium species were not affected. Few ciprofloxacin resistant strains were isolated but did not lead to colonization. In a randomized study 56 patients with acute leukemia received either ciprofloxacin or trimethoprim-sulfamethoxazole plus colistin for prevention of infections. Six major infections occurred in 28 patients receiving ciprofloxacin, and 11 major infections in 28 patients receiving trimethoprim-sulfamethoxazole plus colistin. No infections caused by Gram-negative bacilli were seen in the ciprofloxacin group compared to 17 in the other group (p less than 0.02). Ciprofloxacin prevented colonization with resistant Gram-negative bacilli while 12 resistant colonizing strains were isolated from 10 patients receiving trimethoprim-sulfamethoxazole (p less than 0.01). Ciprofloxacin was better tolerated than trimethoprim-sulfamethoxazole + colistin; fewer side effects occurred.

Topics: Adult; Bacterial Infections; Ciprofloxacin; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Humans; Leukemia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty-six patients receiving remission induction treatment for acute leukemia were studied in a randomized trial comparing ciprofloxacin with trimethoprim-sulfamethoxazole plus colistin for prevention of infections. Both groups received amphotericin B for antifungal prophylaxis. Six major infections occurred in 28 patients receiving ciprofloxacin, and 11 major infections occurred in 28 patients receiving trimethoprim-sulfamethoxazole plus colistin. No infections caused by gram-negative bacilli were seen in the ciprofloxacin group (p less than 0.02). Ciprofloxacin prevented colonization with resistant gram-negative bacilli, but 12 resistant colonizing strains were isolated from 10 patients receiving trimethoprim-sulfamethoxazole plus colistin (p less than 0.01). Ciprofloxacin was better tolerated: 23 of 28 patients were highly compliant to the drug, compared with 15 of 28 patients in the trimethoprim-sulfamethoxazole group (p less than 0.05). These results suggest that ciprofloxacin is a promising drug for the prevention of infection in patients with granulocytopenia.

Topics: Acute Disease; Agranulocytosis; Bacterial Infections; Ciprofloxacin; Colistin; Drug Combinations; Drug Resistance, Microbial; Humans; Leukemia; Leukemia, Lymphoid; Patient Compliance; Random Allocation; Sulfamethizole; Sulfathiazoles; Trimethoprim

Topics: Administration, Oral; Adolescent; Adult; Aged; Agranulocytosis; Antineoplastic Agents; Clinical Trials as Topic; Colistin; Gentamicins; Humans; Leukemia; Middle Aged; Neutropenia; Nystatin; Sepsis; Vancomycin

Several prospectively randomized trials have shown that the administration of prophylactic oral nonabsorbable antibiotics may be beneficial in decreasing the incidence of infection in granulocytopenic patients, whereas others have not. Intolerable nausea and vomiting have prevented the prolonged use of these agents in some studies. Discontinuation of therapy while patients are still granulocytopenic has carried the risk of life-threatening infections, often with aminoglycoside-resistant gram-negative organisms. The benefit of selective decontamination with trimethoprim/sulfamethoxazole used prophylactically remains controversial. The use of trimethoprim/sulfamethoxazole may also be associated with the development of resistant, potentially pathogenic, organisms or prolonged neutropenia. These regimens do not appear to be indicated when patients are anticipated to be neutropenic for less than three weeks. Even in patients with prolonged neutropenia, the risks of such treatment must be weighed against potential benefits.

Topics: Acute Disease; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Environment, Controlled; Gentamicins; Humans; Leukemia; Neoplasms; Nystatin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

43 patients undergoing treatment for acute leukaemia were randomised to receive either co-trimoxazole alone or co-trimoxazole with framycetin and colistin as antibacterial prophylaxis during periods of neutropenia. There were no significant differences between the two treatment groups in the time before the onset of the first fever, the number of episodes of fever or of septicaemia per patient, the number of neutropenic days during which patients remained afebrile or did not require systemic antibiotics, or the number of resistant organisms acquired. Co-trimoxazole alone is cheaper and easier to take than co-trimoxazole with framycetin and colistin, and it is therefore preferable to the three-drug combination for the prophylaxis of bacterial infection.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Clinical Trials as Topic; Colistin; Drug Combinations; Drug Therapy, Combination; Female; Framycetin; Humans; Leukemia; Male; Middle Aged; Neutropenia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A comparative study of infectious morbidity and mortality in neutropenic patients with acute leukemia receiving chemotherapy was undertaken to test the effects of a suppression of endogenous and ambient microorganisms. Patients were allocated to receive [1] oral antibiotics (neomycin, colistin, and nystatin) in conventional ward isolation; [2] no antimicrobial suppression but conventional ward isolation; [3] strict isolation, filtered air, sterilized food and oral antibiotics. Significantly fewer infections with Gram-negative bacilli were seen in patients with strict isolation plus endogenous microbial suppression versus patients receiving selective gut decontamination versus patients without nonabsorbable antibiotics in simple reverse isolation. The death rate from infection was significantly reduced in patients who received antibiotics for gut flora suppression in conventional ward isolation compared with the corresponding control group. In addition, a significant improvement of leukemic remission rate was seen in this group. The protocol for decontamination was well tolerated.

Topics: Adolescent; Adult; Antineoplastic Agents; Colistin; Digestive System; Humans; Infection Control; Leukemia; Neomycin; Nystatin; Patient Isolation; Patient Isolators

113 patients being treated for acute non-lymphoblastic leukaemia were investigated to determine the effect of suppression of body microbial flora on prevention of infection. They were randomly allocated to a control group or a group which received non-absorbed antibiotics by mouth and topical applications of cutaneous and mucosal antiseptic preparations. The group receiving oral non-absorbed antibiotics had significantly few infections, fewer deaths from infection, fewer pyrexial episodes, and consequently received less systemic antibiotic therapy than the controls.

Topics: Acute Disease; Administration, Oral; Administration, Topical; Adolescent; Adult; Antineoplastic Agents; Bacterial Infections; Bacteroides Infections; Chlorhexidine; Colistin; Drug Combinations; Enterobacteriaceae Infections; Framycetin; Humans; Leukemia; Nystatin; Remission, Spontaneous; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections

Bacterial infections in immunocompromised patients are associated with a high mortality and morbidity rate. In this high-risk group, the presence of multidrug-resistant (MDR) bacteria, particularly bacteria that harbor a transferable antibiotic resistance gene, complicates the management of bacterial infections. In this study, we investigated the presence of the transferable colistin resistance mcr genes in patients with leukemia in Spain.. 217 fecal samples collected in 2013-2015 from 56 patients with acute leukemia and colonized with MDR Enterobacteriaceae strains, were screened on September 2017 for the presence of the colistin resistance mcr genes (mcr-1 to -5) by multiplex PCR. mcr positive strains selected on LBJMR and MacConkey supplemented with colistin (2 μg/ml) media were phenotypically and molecularly characterized by antimicrobial susceptibility testing, minimum inhibitory concentration, multilocus sequence typing and plasmid characterization.. Among 217 fecal samples, 5 samples collected from 3 patients were positive for the presence of the mcr-1 colistin-resistance gene. Four Escherichia coli strains were isolated and exhibited resistance to colistin with MIC = 4 μg/ml. Other genes conferring the resistance to β-lactam antibiotics have also been identified in mcr-1 positive strains, including bla. To the best of our knowledge, we have identified the mcr-1 gene for the first time in leukemia patients in Spain. In light of these results, strict measures have been implemented to prevent its dissemination.

Topics: Anti-Bacterial Agents; beta-Lactamases; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Leukemia; Microbial Sensitivity Tests; Middle Aged; Plasmids; Spain

Carbapenem resistance among the Enterobacteriaceae is a serious healthcare challenge. bla IMI is a carbapenemase gene mediating resistance to carbapenems but has not been commonly found. A bla IMI-carrying Enterobacter cloacae, which was also resistant to colistin, is reported here.. E. cloacae strain WCHECl-1060 was recovered from a blood sample of a leukemia patient, who was not previously exposed to colistin. Strain WCHECl-1060 belongs to a new sequence type, ST410, and was resistant to carbapenems and colistin but was susceptible to third-generation cephalosporins. A new allelic variant of bla IMI-1, which has two silent mutations compared to the original bla IMI-1 variant, was found in strain WCHECl-1060. Conjugation and transformation experiments failed to transfer bla IMI-1, suggesting a likely chromosome origin.. To our knowledge, this is the first report of an IMI-1 carbapenemase-producing colistin-resistant E. cloacae in China. Microbiological laboratories should be aware of the unusual carbapenem-resistant but third-generation cephalosporin-susceptible profiles of these IMI-producing isolates. The trend of colistin resistance among the Enterobacteriaceae should be also monitored.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; beta-Lactamases; Carbapenems; China; Colistin; Conjugation, Genetic; DNA, Bacterial; Drug Resistance, Bacterial; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Leukemia; Male; Molecular Sequence Data; Molecular Typing; Sequence Analysis, DNA

Topics: Acute Disease; Bacterial Infections; Colistin; Drug Evaluation; Drug Therapy, Combination; Framycetin; Humans; Leukemia; Neomycin; Nystatin; Patient Isolation

Topics: Carbenicillin; Colistin; Drug Therapy, Combination; Gentamicins; Humans; Leukemia; Prognosis

Topics: Carbenicillin; Colistin; Ecthyma; Gentamicins; Humans; Leukemia; Leukemia, Lymphoid; Lymphoma; Meningitis; Neutropenia; Pneumonia; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Uremia

Topics: Adolescent; Adult; Agranulocytosis; Amphotericin B; Blood Transfusion; Child; Colistin; Humans; In Vitro Techniques; Infection Control; Infections; Leukemia; Male; Methicillin; Oxacillin; Polymyxins; Prednisone

Topics: Abscess; Cellulitis; Colistin; gamma-Globulins; Humans; Infections; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Methicillin; Neoplasms; Pharmacology; Pneumonia; Prednisone; Sepsis; Sinusitis; Statistics as Topic; Urinary Tract Infections