trimethoprim--sulfamethoxazole-drug-combination and Breast-Neoplasms

Chryseobacterium meningosepticum is a ubiquitous Gram-negative bacillus historically associated with meningitis in premature neonates. We report 15 positive cultures and 6 cases of infection among immunocompromised adults at our institution over a 10-year period and review the English-language literature on C. meningosepticum. Excluding the present series, there are 308 reports of positive cultures in the literature, of which 59% were determined to represent true infections. Sixty-five percent of those infected were younger than 3 months of age. Meningitis was the most common infectious syndrome among neonates, seen in 84% of cases and associated with a 57% mortality rate. Less commonly reported infections among infants included sepsis (13%) and pneumonia (3%). Pneumonia was the most frequent infection among the postneonatal group, accounting for 40% of cases, followed by sepsis (24%), meningitis (18%), endocarditis (3%), cellulitis (3%), abdominal infections (3%), eye infections (3%), and single case reports of sinusitis, bronchitis, and epididymitis. The 6 cases in our series were all adults, with a mean age of 58.7 years. Sites of C. meningosepticum infection were limited to the lungs, bloodstream, and biliary tree. Infection in our series was associated with prolonged hospitalization, prior exposure to multiple antibiotics, and host immunocompromise, particularly neutropenia. C. meningosepticum is resistant to multiple antibiotics, and disk dilution is notoriously unreliable for antibiotic sensitivity testing. Sensitivity testing on the 15 isolates from our institution revealed the most efficacious antibiotics to be minocycline (100% sensitive), rifampin (93%), trimethoprim-sulfamethoxazole (67%), and ciprofloxacin (53%). In contrast to reports in the literature, the isolates in our series displayed widespread resistance to vancomycin (100% resistant or intermediately sensitive), erythromycin (100%), and clindamycin (86%). These findings have important implications for the clinician when choosing empiric antibiotic regimens for patients with risk factors for C. meningosepticum infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Breast Neoplasms; Ciprofloxacin; Drug Resistance, Microbial; Female; Flavobacterium; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Infant; Infant, Newborn; Leukemia, Myeloid, Acute; Liver Transplantation; Male; Meningitis, Bacterial; Middle Aged; Minocycline; Pneumonia, Bacterial; Rifampin; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

A 49-year-old woman had been treated with adjuvant dose-dense chemotherapy for left breast cancer pT2N2aM0, Stage ⅢA. She developed a fever of over 38°C on day 13 of the third course of dose-dense doxorubicin/cyclophosphamide (AC)chemotherapy. She was started on oral levofloxacin, but the fever did not resolve. COVID-19 PCR test was positive and chest CT scan showed bilateral ground-glass opacities. She was diagnosed with COVID-19 pneumonia and hospitalized. The fever did not resolve even after sotrovimab and remdesivir were administered. On the 5th hospital day, the serum β-D-glucan level was found to be elevated(81.7 pg/mL), and she was diagnosed with concurrent COVID-19 and Pneumocystis jirovecii pneumonia(PCP). After the start of sulfamethoxazole-trimethoprim(TMP-SMX), the fever resolved quickly. After discharge from hospital, ground-glass opacities had disappeared. She resumed dose-dense chemotherapy with TMP-SMX and completed without fever. In immunosuppressed patients with cancer drug therapy, it is necessary to make a differential diagnosis of various types of pneumonia and to consider the different types of pneumonia may occur simultaneously.

Topics: Breast Neoplasms; COVID-19; Female; Humans; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Androstadienes; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Cyclin-Dependent Kinase 4; Cyclin-Dependent Kinase 6; Fatal Outcome; Female; Humans; Immunocompromised Host; Lymphocyte Count; Lymphopenia; Piperazines; Pneumocystis; Pneumonia, Pneumocystis; Pyridines; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bendamustine Hydrochloride; Bevacizumab; Breast Neoplasms; CD4 Lymphocyte Count; Clinical Trials, Phase I as Topic; Dexamethasone; Erlotinib Hydrochloride; Female; Humans; Lung Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Nitrogen Mustard Compounds; Paclitaxel; Pneumocystis carinii; Pneumonia, Pneumocystis; Quinazolines; Trimethoprim, Sulfamethoxazole Drug Combination

Patients who have undergone prior chest wall irradiation can present as challenging candidates for implant reconstruction because of troublesome rates of infectious complications. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well described in the literature. The purpose of this study was to determine the efficacy of extended trimethoprim/sulfamethoxazole therapy in preventing implant infections in the irradiated chest wall.. A retrospective chart review of hospital and office records was performed on all patients undergoing implant reconstruction performed by a single surgeon (J.M.S.) from August of 2005 to March of 2008. Before 2007, the senior author used 5 to 7 days of cephalosporin prophylaxis. Subsequent to this period, the prophylactic regimen was amended to provide patients with previous chest wall irradiation prophylactic trimethoprim/sulfamethoxazole for 30 days after implant insertion.. Fifty-one implant reconstructions, in the setting of prior ipsilateral chest wall irradiation, were performed. The mean follow-up time was 39 months. The infection rate for the routine cephalosporin group was 35 percent as compared with 8 percent for the extended trimethoprim/sulfamethoxazole group (p = 0.038). After multivariate analysis, extended trimethoprim/sulfamethoxazole remained the only significant factor that influenced the rate of infection (p = 0.05). The mean time to infection was 13 weeks for the routine cephalosporin group and 1.5 weeks for the extended trimethoprim/sulfamethoxazole group (p = 0.044).. Extended trimethoprim/sulfamethoxazole therapy demonstrates preliminary evidence as an effective adjunctive measure for reducing the rate of implant infections in breast reconstruction.. Therapeutic, III.

Topics: Adult; Algorithms; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Breast Implants; Breast Neoplasms; Cephalosporins; Female; Humans; Logistic Models; Middle Aged; Multivariate Analysis; Prosthesis-Related Infections; Retrospective Studies; Thoracic Wall; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents; Biopsy; Breast Neoplasms; Cyclophosphamide; Female; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Breast Neoplasms; Collagen; Female; Humans; Mastectomy; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Skin Ulcer; Skin, Artificial; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma, Ductal, Breast; Cyclophosphamide; Dexamethasone; Doxorubicin; Female; Fever; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Middle Aged; Neutropenia; Paclitaxel; Pneumonia, Pneumocystis; Polyethylene Glycols; Prednisone; Recombinant Proteins; Trimethoprim, Sulfamethoxazole Drug Combination

The extent and duration of neutropenia and the characteristics of the underlying disease are determinant factors for the prognosis of febrile syndromes. Despite the fact that traditionally the peripheral blood stem cell transplantation (PBSCT) were considered to cause high risk neutropenia, in all probability the neutropenia observed in the PBSCT in some solid tumours could be considered moderate risk. Febrile episodes in patients with these characteristics were evaluated.. We prospectively analysed 132 autologus PBSCT in patients with breast cancer (1994-1999). Conditioning regime: STAMP V. Antibacterial prophylaxis: ofloxacin (400 mg/12 hrs PO). Classification of the febrile syndrome: bacteremia, microbiologically documented infection withut bacteremia, clinical infection and a fever of unknown origin.. 122 patients had a fever (92%), mean age: 45 years (range: 27-61). There were 32 (26%) bacteremias, 13 (11%) microbiologically documented infections without bacteremia and 54 (44%) clinical infections. The mean number of days with a neutrophil count of <1x109/1 was 14 (range: 11-20). In the 74 patients (61%) that had a granulocyte colony stimulating factor (G-CSF), the mean number of days to reach a 0,5x109/I neutrophil count (7,6) and the average number of days in hospital (26) were significantly less. There was a main infectious point in 80 patients (65%): the most frequent being oropharynx in 33 cases (46%) and digestive in 29 cases (41%). 48 gram negative (GN) 29 gram positive (GP) bacteria were isolated (71% of the GN's were resistant to ofloxacin). Between 1997-1999 the GN/GP ratio was 2,3. There were no deaths related to the infection.. Given the excellent evolution of our patients we can consider their neutropenia to be moderate or low risk, and they are a long way from the death rates caused by infections published by other types of hemopoietic transplants. The predominance of GN over the last few years and their limited sensitivity to quinolones means that their prophylactic use in these patients should be reconsidered.

Topics: Acyclovir; Adult; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Bacteremia; Bacterial Infections; Breast Neoplasms; Carboplatin; Combined Modality Therapy; Cyclophosphamide; Drug Resistance; Female; Fever; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Incidence; Infection Control; Middle Aged; Neutropenia; Ofloxacin; Premedication; Prospective Studies; Transplantation Conditioning; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Delayed; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

A case of a patient receiving chemotherapy because of breast cancer who developed adult respiratory distress caused by Pneumocystis carinii pneumonia is presented. The evolution was good after treatment with 20 mg/kg/day of trimethoprim and 100 mg/kg/day of sulfamethoxazole.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Combined Modality Therapy; Female; Humans; Pneumonia, Pneumocystis; Respiration, Artificial; Respiratory Distress Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Breast Neoplasms; Drug Combinations; Female; Humans; Middle Aged; Radiodermatitis; Radiotherapy; Skin Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two patients are described in whom sunburn and electron beam radiodermatitis, respectively, were critical determinants in localizing the initial presentation of drug eruptions. In the first instance, a severe sunburn of the back and thighs was followed 7 months later by the appearance of a toxic epidermal necrolysis drug reaction to trimethoprim-sulfamethoxazole in the exact sites of the previous bullous sunburn reaction. In the second patient, a radiodermatitis of the left upper arm due to electron beam therapy for metastatic breast cancer was followed 7 weeks later by a codeine drug reaction confined to the area of the radiodermatitis. In both instances, oral rechallenge with the offending drug reproduced the eruption.

Topics: Adult; Breast Neoplasms; Codeine; Drug Combinations; Drug Eruptions; Female; Humans; Middle Aged; Radiodermatitis; Skin; Sulfamethoxazole; Sunburn; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination