dibekacin and Lymphoma

Patients with malignancy, especially those with hematological malignancy, are well known to be very susceptible to infection in general, because of bone marrow suppression induced by anticancer chemotherapy in addition to the nature of the disease itself. Accordingly, the risk of MRSA infection is very high in these patients, and the infection is often fatal. In an attempt to establish effective measures to prevent MRSA infection, we investigated the nosocomial spread of strains of MRSA and studied the characteristics of patients from the clinical standpoint. We found that strict isolation of patients with MRSA infection is an urgent necessity to prevent the intrahospital spread of MRSA strains and that disinfection of the hands of medical staff and sterilization of the environment are extremely important. In addition, due care must be taken to select an adequate antimicrobial agent and to determine the optimal dose and period for treatment of the infection in patients with malignancy to avoid selecting MRSA strains or inducing resistance in mecA positive strains of S. aureus. For treatment of MRSA infections in patients with malignancy, a combination chemotherapy with vancomycin (VCM), or arbekacin (ABK) plus beta-lactam antibiotic is recommended, and granulocyte colony stimulating factor (G-CSF) is clinically useful when the granulocytopenia was induced by chemotherapy.

Topics: Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Antineoplastic Agents; Cross Infection; Dibekacin; Disinfection; Female; Humans; Leukemia; Lymphoma; Male; Methicillin Resistance; Middle Aged; Patient Isolation; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Arbekacin (ABK) was administered to 17 patients with MRSA infections that complicated underlying hematopoietic disorders, and the efficacy and safety were evaluated. The underlying diseases included acute myelocytic leukemia (8 cases), acute lymphocytic leukemia (1) myelodysplastic syndrome (3), chronic myelocytic leukemia (1), non-Hodgkin's lymphoma (2), Hodgkin's disease (1) and adult T cell leukemia (1). The infections consisted of septicemia (5 cases), pneumonia (4), upper respiratory tract infections (6) and urinary tract infections (2). ABK was administered by i.v. drip infusion in daily doses of 150-200 mg, given in two divided dosages. The therapeutic efficacies were: excellent in 2 (2 septicemias), good in 7 (1 septicemia, 4 upper respiratory infections, 2 urinary tract infections), fair in 2 (septicemia and pneumonia) and poor in 6 (1 septicemia, 3 pneumonias, 2 upper respiratory infections). As a side effect, reversible renal dysfunction was detected in four cases. Causative bacteria were isolated from six cases. They were all coagulase type II and MIC's of ABK were from 0.25 microgram/ml to 4.0 micrograms/ml. Arbekacin therapy was found to be effective even in patients with hematopoietic disorders accompanied by MRSA infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Drug Therapy, Combination; Female; Humans; Kidney; Leukemia; Lymphoma; Male; Methicillin Resistance; Middle Aged; Staphylococcal Infections; Staphylococcus aureus