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Ivanka, Perčić. "Serumski adiponektin i insulinska rezistencija u febrilnoj neutropeniji kod bolesnika sa akutnom nelimfoblastnom leukemijom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. https://www.cris.uns.ac.rs/record.jsf?recordId=95376&source=NDLTD&language=en.
Full textAbstract:
Uvod: Febrilna neutropenija, kao prvi znak infekcije, je česta komplikacija u fazi postterapijske aplazije kostne srži u obolelih od akutne nelimfoblastne leukemije. Klinička slika febrilne neutropenije može biti suptilna, a progresija u stanje septičnog šoka znatno brža nego kod imunokompetentnih bolesnika. Rana predikcija rizika od komplikacija febrilne neutropenije i uvođenje empirijske antibiotske terapije može da poboljša prognozu bolesnika. Insulinska rezistencija, dislipidemija i inflamacija masnog tkiva se javljaju u sklopu sistemske inflamacije. Njihova uloga i značaj kao potencijalnih faktora predikcije toka i ishoda febrilne neutropenije nisu ispitani. Ciljevi istraživanja: Ustanoviti promene pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina pre i u fazi febrilne neutropenije kod bolesnika sa akutnom nelimfoblastnom leukemijom. Uporediti vrednosti pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina bolesnika sa akutnom nelimfoblastnom leukemijom pre početka febrilne neutropenije i kontrolne grupe gojaznih. Uporediti vrednosti pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina bolesnika sa akutnom nelimfoblastnom leukemijom u fazi febrilne neutropenije i kontrolne grupe gojaznih. Utvrditi da li su pokazatelj stepena insulinske senzitivnosti, ukupni serumski holesterol, trigliceridi, HDL - holesterol, LDL - holesterol, apolipoprotein A-I, lipoprotein (a) i adiponektin bolesnika sa akutnom nelimfoblastnom leukemijom u fazi febrilne neutropenije u korelaciji sa vrednostima parametara inflamacije, njenim tokom i ishodom. Materijal i metode: Istraživanje je sprovedeno u Klinici za hematologiju i Klinici za endokrinologiju, dijabetes i bolesti metabolizma. Obuhvatilo je 60 ispitanika, od kojih je 30 ispitanika obolelo od akutne nelimfoblastne leukemije, a 30 ispitanika je činilo kontrolnu grupu gojaznih. Nakon uključivanja u istraživanje, ispitanicima su urađeni predviđeni pregledi i laboratorijske analize u cilju procene insulinske senzitivnosti, metaboličkog statusa i serumskog adiponektina. Navedena merenja su urađena pre hemioterapije i u febrilnoj neutropeniji. Zdravstveno stanje ispitanika je praćeno do kraja prve hospitalizacije. Statistička obrada je izvršena uz pomoć statističkog paketa Statistica. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost je odreĎivana na nivou p < 0.05. Rezultati: U febrilnoj neutropeniji bolesnika sa akutnom leukemijom je došlo do razvoja insulinske rezistencije (t = - 2.43, p = 0.021), dislipidemije sa značajnim sniţenjem ukupnog holesterola (t = 3.59, p = 0.0012), LDL – holesterola (t = 3.56, p = 0.0013) i apoA – I (t = 2.27, p = 0.03). Oboleli od akutne nelimfoblastne leukemije u febrilnoj neutropeniji su razvili metaboličke promene viđene kod gojaznih osoba sa insulinskom rezistencijom. Nastanak i progresija insulinske rezistencije je bila u pozitivnoj korelaciji sa fibrinogenom kao pokazateljem težine inflamacije (r = 0.59, p < 0.05) dok je apoA - I negativno korelirao sa CRP (r = - 0.37, p < 0.05). Ispitanici sa nižom insulinemijom i vrednostima HDL - holesterola pre hemoterapije su imali značajno bolji tok febrilne neutropenije (t = -2.38, p = 0.024 vs. t = - 2.87, p = 0.007). Ispitanici sa većim indeksom telesne mase (BMI) i obimom struka imali su povoljniji ishod febrilne neutropenije (r = - 0.47, p < 0.05 vs. r = - 0.40, p < 0.05). Drugi pokazatelji insulinske senzitivnosti, metaboličkog statusa i adiponektin nisu značajno uticali na tok i ishod febrilne neutropenije. Normalna telesna masa pre hemioterapije, a u febrilnoj neutropeniji temperatura u trajanju dužem od 7 dana, niže vrednosti MASCC indeksa rizika, više vrednosti CRP, više vrednosti adiponektina, niže vrednosti Lp(a) i komplikovan tok febrilne neutropenije su bili prediktori lošije prognoze febrilne neutropenije. Zaključak: Pored klasičnih hematoloških parametara potrebno je uzeti u obzir antropometrijske karakteristike, redistribuciju masne mase, disfunkcionalnost masne mase, insulinsku rezistenciju i metaboličke parametre u cilju praćenja i predviđanja mogućih komplikacija i komorbiditeta.Introduction: Febrile neutropenia is a common complication in posttreatment aplasia in patients with acute nonlymphoblastic leukemia. Its clinical manifestation can be subtle. However, it can progress to septic shock more quickly than in immunocompetent patients. Early prediction of complications and recognition of risk factors can improve outcome. Systemic inflammation is characterized by insulin resistance, dyslipidemia and adipocyte dysfunction. However, their importance in predicting complications and outcome of febrile neutropenia is not entirely known.Aims: To determine changes in HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients before chemotherapy and during febrile neutropenia. To compare HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients before chemotherapy and the obese. To compare HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients during febrile neutropenia and the obese. To determine whether HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in febrile neutropenia are in correlation with the severity of the infection, appearance of complications and outcome. Materials and methods: The study was conducted at the Clinic for hematology and Clinic for endocrinology, diabetes, and metabolic disorders. 60 patients who fulfilled the inclusion criteria were included in the study. 30 patients had acute leukemia, and 30 were obese. Clinical and laboratory examination to assess insulin sensitivity, metabolic disorders and adiponectin was done before chemotherapy and during febrile neutropenia. Patients were followed up until the end of the first hospitalization. Data were analyzed with Statistica software and presented in tables and graphs. Statistical significance was set at p<0.05. Results: During febrile neutropenia, patients with acute leukemia developed insulin resistance (t = - 2.43, p = 0.021), alongside significant decline of total cholesterol (t = 3.59, p = 0.0012), LDL – cholesterol (t = 3.56, p = 0.0013) and apoA – I (t = 2.27, p = 0.03). In acute inflammation, metabolic changes in patients with acute leukemia resembled those in the obese with insulin resistance. HOMA-IR values were in positive correlation with fibrinogen (r = 0.59, p < 0.05) whereas apoA-I was in negative correlation to CRP (r = - 0.37, p < 0.05). Patients with higher body mass index and waist circumference had better course and outcome of febrile neutropenia (r = - 0.47, p < 0.05 vs. r = - 0.40, p < 0.05). Patients with lower insulin levels and HDL - cholesterol prior to chemotherapy had a significantly better course of febrile neutropenia (t = -2.38, p = 0.024 vs. t = - 2.87, p = 0.007). Other parameters of insulin sensitivity, metabolic status, and adiponectin did not influence the course and outcome of inflammation significantly. Normal body weight, duration of febrile neutropenia for longer than 7 days, lower MASCC risk index, higher CRP and adiponectin, low Lp(a) in febrile neutropenia and a complicated course od febrile neutropenia were predictors of a worse outcome. Conclusion: Besides known hematological risk factors for complications in febrile neutropenia, anthropometric characteristics, fat mass distribution and disfunction, insulin resistance and metabolic parameters are useful predictors of the course and outcome of febrile neutropenia.
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Urbonas, Vincas. "Biomarkers of bacteremia and sepsis in pediatric oncology patients with febrile neutropenia." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2013~D_20131115_080913-61678.
Full textAbstract:
This study was designed to evaluate the response of innate immunity to acute bacterial inflammation in terms of cytokines and other biomolecules concentration changes in the blood of investigated childhood oncology patients during the beginning of febrile neutropenia (FN) episode and to assess the relevance of these biomarkers for sepsis/bacteremia evaluation. This study was performed at Vilnius University Children Hospital and State Research Institute Centre for Innovative Medicine from 2009 to 2011. Serum samples were collected during 82 fever episodes in a total of 53 oncology patients. The study population consisted of pediatric oncology patients admitted to the hospital with the diagnosis of neutropenia and fever. According to microbiological and clinical findings, patients with episodes of FN were classified into 2 groups: 1) fever of unknown origin (FUO) group – patients with negative blood culture, absence of clinical signs of sepsis and clinically or microbiologically documented local infection, 2) septic/bacteremia (SB) group – patients with positive blood culture (documented Gram-positive or Gram-negative bacteremia) and/or clinically documented sepsis. We measured the levels of cytokines (IL-6, IL-8, IL-10), their receptors (sIL-2R) and other biomarkers (PCT, CRP, sHLA-G) for three consecutive days. We showed that on day 1 the most accurate biomarkers for bacteremia/sepsis discrimination were cytokines (IL-6, IL-10, IL-8), on day 2 – IL-8 and PCT. On day 1 the... [to full text]Viena iš pagrindinių taikomos šiuolaikinės intensyvios chemoterapijos komplikacijų yra organizmo imuninės sistemos slopinimas ir su tuo susijusi neutropenija, kuri savo ruožtu sąlygoja padidėjusią riziką susirgti bakterinės kilmės infekcinėmis ligomis. Šio darbo tikslas buvo įvertinti ūmaus bakterinio uždegimo bei sepsio patogenezėje dalyvaujančių citokinų (IL-6, IL-8, IL-10), citokinų receptorių (sIL-2R), ūmios fazės baltymų bei kitų imuninio atsako komponentų (CRB, PCT, sHLA-G) tinkamumą bakterinio proceso ankstyvai diagnostikai tarp pacientų su febrline neutropenija (FN), šių biožymenų tinkamumą ir pritaikomumą kasdienėje klinikinėje praktikoje. Tiriamoji medžiaga surinkta 2009–2011 m. Vilniaus universiteto Vaikų ligoninės Onkohematologijos skyriuje. Į tyrimą buvo įtraukta 53 onkohematologinėmis ligomis sergantys vaikai su FN, kurie gydymo eigoje turėjo 82 karščiavimo epizodus. Nuo pirmos karščiavimo dienos tris dienas iš eilės buvo imami kraujo mėginiai bei nustatomos citokinų (IL-6, IL-8, IL-10), CRB, PCT, sHLA-G ir sIL-2R koncentracijos. Remiantis klinikinių bei mikrobiologinių tyrimų duomenimis, FN epizodai buvo suskirstyti į dvi grupes – neaiškios kilmės karščiavimo (NKK), į kurią buvo įtraukti pacientai be sepsio požymių bei su neigiamais mikrobiologiniais pasėliais ir bakteriemijos/sepsio (BS). BS grupę sudarė pacientai su teigiamais mikrobiologiniais pasėliais ir(ar) kliniškai diagnozuotu sepsiu. Mūsų atlikto tyrimo rezultatais bakteriemijos/sepsio vertinimui FN... [toliau žr. visą tekstą]
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Urbonas, Vincas. "Vaikų, sergančių navikinėmis ligomis, bakteriemijos bei sepsio biožymenys febrilinės neutropenijos epizodo metu." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2013~D_20131115_080926-38717.
Full textAbstract:
Viena iš pagrindinių taikomos šiuolaikinės intensyvios chemoterapijos komplikacijų yra organizmo imuninės sistemos slopinimas ir su tuo susijusi neutropenija, kuri savo ruožtu sąlygoja padidėjusią riziką susirgti bakterinės kilmės infekcinėmis ligomis. Šio darbo tikslas buvo įvertinti ūmaus bakterinio uždegimo bei sepsio patogenezėje dalyvaujančių citokinų (IL-6, IL-8, IL-10), citokinų receptorių (sIL-2R), ūmios fazės baltymų bei kitų imuninio atsako komponentų (CRB, PCT, sHLA-G) tinkamumą bakterinio proceso ankstyvai diagnostikai tarp pacientų su febrline neutropenija (FN), šių biožymenų tinkamumą ir pritaikomumą kasdienėje klinikinėje praktikoje. Tiriamoji medžiaga surinkta 2009–2011 m. Vilniaus universiteto Vaikų ligoninės Onkohematologijos skyriuje. Į tyrimą buvo įtraukta 53 onkohematologinėmis ligomis sergantys vaikai su FN, kurie gydymo eigoje turėjo 82 karščiavimo epizodus. Nuo pirmos karščiavimo dienos tris dienas iš eilės buvo imami kraujo mėginiai bei nustatomos citokinų (IL-6, IL-8, IL-10), CRB, PCT, sHLA-G ir sIL-2R koncentracijos. Remiantis klinikinių bei mikrobiologinių tyrimų duomenimis, FN epizodai buvo suskirstyti į dvi grupes – neaiškios kilmės karščiavimo (NKK), į kurią buvo įtraukti pacientai be sepsio požymių bei su neigiamais mikrobiologiniais pasėliais ir bakteriemijos/sepsio (BS). BS grupę sudarė pacientai su teigiamais mikrobiologiniais pasėliais ir(ar) kliniškai diagnozuotu sepsiu. Mūsų atlikto tyrimo rezultatais bakteriemijos/sepsio vertinimui FN... [toliau žr. visą tekstą]This study was designed to evaluate the response of innate immunity to acute bacterial inflammation in terms of cytokines and other biomolecules concentration changes in the blood of investigated childhood oncology patients during the beginning of febrile neutropenia (FN) episode and to assess the relevance of these biomarkers for sepsis/bacteremia evaluation. This study was performed at Vilnius University Children Hospital and State Research Institute Centre for Innovative Medicine from 2009 to 2011. Serum samples were collected during 82 fever episodes in a total of 53 oncology patients. The study population consisted of pediatric oncology patients admitted to the hospital with the diagnosis of neutropenia and fever. According to microbiological and clinical findings, patients with episodes of FN were classified into 2 groups: 1) fever of unknown origin (FUO) group – patients with negative blood culture, absence of clinical signs of sepsis and clinically or microbiologically documented local infection, 2) septic/bacteremia (SB) group – patients with positive blood culture (documented Gram-positive or Gram-negative bacteremia) and/or clinically documented sepsis. We measured the levels of cytokines (IL-6, IL-8, IL-10), their receptors (sIL-2R) and other biomarkers (PCT, CRP, sHLA-G) for three consecutive days. We showed that on day 1 the most accurate biomarkers for bacteremia/sepsis discrimination were cytokines (IL-6, IL-10, IL-8), on day 2 – IL-8 and PCT. On day 1 the... [to full text]
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Bellesso, Marcelo. "Tratamento ambulatorial da neutropenia febril." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5167/tde-02062009-093637/.
Full textAbstract:
INTRODUÇÃO: A neutropenia febril (NF) é uma complicação freqüente e potencialmente fatal no manejo do paciente onco-hematológico. Estudos recentes demonstram que a NF consiste em um grupo heterogêneo de pacientes com riscos variados. Nosso objetivo foi avaliar a taxa de falência ao tratamento de primeira linha, taxa de internação e óbito. Além disso, estudamos as variáveis clínico-laboratoriais em relação aos desfechos, a validação do índice Multinational Association for Supportive Care of Cancer (MASCC) modificado e a taxa de positividade de hemocultura e urocultura, como também o perfil de sensibilidade ao cefepima. CASUÍSTICA E METODOLOGIA: Estudo retrospectivo unicêntrico. Os dados foram obtidos através dos prontuários do Hospital-Dia no período de Julho de 2001 a Junho de 2006. Foram avaliados eventos com NF tratados com cefepima 2g (2x/dia), associado ou não, a teicoplamina 400mg/dia. RESULTADOS: Em 128 pacientes, estudamos 178 eventos de NF. A taxa de falência ao tratamento de primeira linha foi de 36,5%, taxa de internação 20,7% e óbito em 6,2% entre os eventos de NF. Na análise multivariada do estudo das categorias clínico-laboratoriais e dos desfechos encontramos como dados significantes em relação ao risco da falência ao tratamento de primeira linha: Idade < 60 anos (OR: 2,11 IC95%: 1,71-2,51, p = 0,004) e creatinina sérica > 1,2mg/dL (OR: 7,19, IC95%: 1,81 30,71 p= 0,005). Os dados significantes para o risco de internação foram: Ausência do diagnóstico de Linfoma não - Hodgkin (OR: 2,42 IC95%: 2,04 2,8, p= 0,011) Tabagismo (OR: 3,14, IC95% 1,14 8,66, p=0,027) e creatinina sérica > 1,2mg/dL (OR: 7,97, IC95% 21,19 - 28,95, p=0,002). Em relação ao óbito, o único dado de risco significante foi a saturação de oxigênio < 95% (OR: 5,8, IC95% 1,50 - 22,56, p = 0,011). Em relação ao índice MASCC modificado e seu impacto sobre os desfechos obtivemos os seguintes resultados: Falência do tratamento de primeira linha e (baixo risco versus alto risco): 35,2% x 53,8%, p=0,232; Internação (baixo risco versus alto risco): 18,2% x 53,8%, p = 0,006; óbito (baixo risco versus alto risco): 4,3% x 30,8%, p=0,004. As taxas de hemocultura e urocultura positivas foram respectivamente: 13% e 8%. O agente isolado mais freqüente nos dois exames foi Eschericia coli. Em relação ao perfil de sensibilidade dos agentes isolados e testados, 100% foram sensíveis ao cefepima. CONCLUSÕES: Os eventos de NF em tratamento ambulatorial apresentaram taxas satisfatórias em relação aos desfechos. Os dados sugerem que os riscos como: Ausência de Linfoma não - Hodgkin, tabagismo, creatinina sérica > 1,2mg/dL e oximetria de pulso < 95% merecem ser considerados como fatores de riscos para desfechos indesejáveis. O índice MASCC modificado mostrou-se eficaz para classificar os eventos classificados como alto risco na nossa população. Em relação aos agentes isolados e testados, 100% são sensíveis ao antibiótico de primeira linha cefepima.BACKGROUND AND OBJECTIVES: Febrile Neutropenia (FN) is a frequent adverse event and potentially lethal in patients with haematologic malignancies. Nowadays, FN represents a heterogeneous group with different risk for serious complications and death. We studied the first line antibiotic failure, hospitalization rate and death. In addition, it was compared clinical and laboratory data with outcomes, validation of the usefulness of Modified Multinational Association for Supportive Care of Cancer (MASCC) and blood culture and urine culture rate identification. DESIGN AND METHODS: We elaborated a retrospective study. It was evaluated patients with haematologic malignancies who were treated with Cefepime 2g intravenous (IV) twice a day, with or without Teicoplanin 400mg (IV) once a day. RESULTS: Of the 178 FN events, it was observed: first line antibiotic failure 36,5%, hospitalization rate 20,7% and deaths 6,2%. In multivariate analyses, it was evidenced with risk to first line antibiotic failure: Age < 60 years (OR: 2,11, CI95%: 1,71-2,51, p =0,004), serum creatinine > 1,2mg/mL (OR: 7,19, CI95%: 1,81 30,71 p= 0,005). In hospitalization the risks were: Without diagnosis of Non- Hodgkin Lymphoma (OR: 2,42, CI95%: 2,04 2,8, p= 0,011), smoking (OR: 3,14, CI95% 1,14 8,66, p=0,027), serum creatinine > 1,2mg/dL (OR: 7,97, CI95%21,19- 28,95, p=0,002). Relating to death, the risk was transcutaneous oximetry < 95% (OR: 5.8, CI95%: 1.50 22.56, p = 0.011). Analyzing MASCC index, 165 events were classified as low-risk and 13 as high-risk. Outpatient treatment failures were reported in connection with 7 (53.8%) high-risk episodes and 30 (18.2%) low-risk, p=0.006. In addition, death in 7 (4.2%) low-risk and 4 (30.8%) high-risk events, p=0.004. Microbiological infection documented was identified in 13% and 8% in blood cultures and urine cultures, respectively. The most common agent isolated was E. coli and 100% were sensitive to cefepime. INTERPRETATIONS AND CONCLUSIONS: The outpatient treatment with intravenous antibiotic was satisfactory. The risks: Haematologic malignancies other than Non-Hodgkin Lymphoma, smoking, serum creatinine elevated and oximetry < 95% should be considered in FN evaluation. It was validated MASCC index in the Brazilian population. Relating to microbiological agents studied 100% were not resistant for cefepime.
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Rosa, Regis Goulart. "Desfechos clínicos em neutropenia febril." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/119418.
Full textAbstract:
Neutropenia febril (NF) constitui complicação frequente do tratamento quimioterápico do câncer e está associada a altas taxas de morbimortalidade. O reconhecimento dos principais fatores associados ao desenvolvimento de desfechos clínicos desfavoráveis na NF é fundamental, uma vez que estes podem ser utilizados como marcadores prognósticos ou alvos terapêuticos. Este estudo objetiva determinar os principais fatores associados com mortalidade, tempo de hospitalização, incidência de bacteremia por patógenos multirresistentes e incidência de choque séptico no início da febre em pacientes hospitalizados com NF secundária à quimioterapia citotóxica para o câncer. Na presente coorte prospectiva composta por 305 episódios consecutivos de NF (em 169 pacientes com câncer) realizada em um hospital terciário no período de outubro de 2009 a agosto de 2011, as seguintes questões de pesquisa foram avaliadas: impacto do tempo de início da antibioticoterapia na mortalidade em 28 dias; fatores relacionados com tempo de hospitalização; impacto dos fatores microbiológicos da bacteremia no desenvolvimento de choque séptico no início do episódio de NF; fatores de risco para bacteremia por patógenos multirresistentes; impacto da bacteremia por Staphylococcus coagulase-negativo na mortalidade em 28 dias. Em 5 publicações distintas, os seguintes resultados foram notados: o atraso do início da antibioticoterapia está associado a maiores taxas de mortalidade em 28 dias; neoplasia hematológica, regimes quimioterápicos de altas doses, duração da neutropenia e bacteremia por Gram-negativos multirresistentes estão associados com períodos prolongados de internação por NF; infecção de corrente sanguínea polimicrobiana, bacteremia por Escherichia coli e bacteremia por Streptococcus viridans estão associados a choque séptico no início do episódio de NF; idade avançada, duração da neutropenia e presença de cateter venoso central estão associados com bacteremia por patógenos multirresistentes; bacteremia por Staphylococcus coagulase-negativo está associada a menores taxas de mortalidade em 28 dias quando comparado à bacteremia por outros patógenos.Febrile neutropenia (FN) is a common complication of cancer chemotherapy and is associated with high morbidity and mortality rates. Recognition of the main factors associated with the development of adverse clinical outcomes in FN is crucial, given that these factors can be used as prognostic markers or therapeutic targets. This study aims to determine the main factors associated with mortality, length of hospital stay, incidence of bacteremia by multidrug-resistant pathogens and incidence of septic shock at the onset of fever in hospitalized patients with FN secondary to cancer cytotoxic chemotherapy. In the present prospective cohort of 305 FN episodes (in 169 cancer patients) conducted at a tertiary hospital from October 2009 to August 2011, the following research questions were evaluated: impact of time to antibiotic administration on 28-day mortality; factors associated with length of hospital stay; impact of microbiological factors of bacteremia on the development of septic shock at the onset of FN; risk factors for bacteremia by multidrug-resistant pathogens; impact of coagulasenegative Staphylococcus bacteremia on 28-day mortality. In 5 distinct publications, the following results were noted: delay of antibiotic administration is associated with higher 28-day mortality rates; hematologic malignancy, high-dose chemotherapy regimens, duration of neutropenia and bacteremia by multidrug-resistant Gram-negative bacteria are associated with prolonged length of hospital stay; polymicrobial bloodstream infection, bacteremia by Escherichia coli, and bacteremia by viridans sreptococci are associated with septic shock at the onset of FN; advanced age, duration of neutropenia and presence of indwelling central venous catheters are associated with bacteremia by multidrug-resistant pathogens; coagulase-negative Staphylococcus bacteremia is associated with lower 28-day mortality rates compared with bacteremia by other pathogens.
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Bossaer, John B., and David Cluck. "Home Health Care of Patients With Febrile Neutropenia." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2319.
Full textAbstract:
Febrile neutropenia is a potentially life-threatening oncologic emergency characterized by a dangerously low neutrophil count that places the patient at great risk. In these patients, fever may be the only sign of infection, which requires prompt treatment. With the increasing focus in shifting health care from inpatient centers to outpatient arenas, home health care clinicians will likely have an increased role in the care of neutropenic fever patients in the future. The article describes both the pharmacologic treatment and nonpharmacologic support required of these patients with particular attention to treatment that may be required in the patient?s home.
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Barbosa, Gustavo Göhringer de Almeida. "Expressão do CD64 como preditor de cultural positivo em crianças com neutropenia febril." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/104077.
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Introdução: Uma em cada 25 crianças com câncer vai morrer devido a complicações da terapia: trata-se de uma em cada seis mortes. Das complicações do tratamento, uma importante causa de morte continua sendo a infecção. Esta frequentemente apresenta-se como febre com neutropenia, mais conhecido como “neutropenia febril”. O reconhecimento precoce de processos infecciosos em pacientes neutropênicos é dificultado pelo fato destes poderem ter apresentações clínicas variadas e não específicas, aguardando-se o início da febre para se começar um tratamento com antibióticos. O CD64 é um marcador de superfície de neutrófilos, detectável por exame de citometria de fluxo e que é pouco expressado em neutrófilos não sensibilizados. Quando o neutrófilo é exposto a TNF- alfa e outros mediadores inflamatórios, este marcador passa a ser ativado e é mensurado através da expressão do Índice de CD64. Justificativa: O diagnóstico precoce de sepse com hemocultura positiva em crianças neutropênicas febris é de suma importância. Os testes laboratoriais disponíveis nos ajudam pouco no momento da chegada deste paciente ao hospital. O diagnóstico mais precoce de uma infecção bacteriana nestes pacientes possibilita um melhor manejo da antibióticoterapia e, consequentemente, uma melhora na sobrevida. Objetivos: O objetivo deste trabalho foi de avaliar a existência de relação entre o valor do índice de CD64 no primeiro dia de neutropenia febril com a positividade da hemocultura. A correlação com outros parâmetros, como número de leucócitos, PCR e VSG também foi avaliada. Metodologia: Este foi um estudo do tipo casos e controles, prospectivo, diagnóstico, com 64 episódios de neutropenia, sendo o grupo de casos definido como aquele com hemoculturas positivas e o controle com hemoculturas negativas. O grupo de casos contou com 14 episódios e o grupo de controle com 50. Por se tratar de uma variável não-paramétrica, utilizamos o teste de Mann-Whitney para relacionar o índice de CD64 com os resultados da hemocultura em cada grupo e com as demais variáveis. Para avaliar a capacidade de prever o resultado de uma hemocultura com o índice de CD64 e também avaliarmos suas medidas de eficácia, utilizamos curva ROC (Receiver Operating Characteristic) Resultados: O grupo de casos contou com 14 pacientes. A mediana do índice de CD64 no grupo de casos foi de 2,1 (±3,9) e para o grupo controles foi de 1,76(±5,02). Os testes de Mann-Whitney não foram capazes de evidenciar relação entre o valor do índice de CD64 e a positividade das hemoculturas. O índice de CD64 também não se mostrou correlacionado com a positividade do PCR. A curva ROC não evidenciou que o Índice de CD64 foi capaz de prever a positividade de uma hemocultura. Com relação às medidas de eficácia, tivemos: Sensibilidade de 64,3%, especificidade de 42% com valor preditivo positivo de 23,7% e valor preditivo negativo de 80%. O valor linear do PCR não apresentou diferença estatísticamente significativa entre os grupos das hemoculturas. Para o PCR as medidas de eficácia do exame foram: Sensibilidade de 71,4%, especificidade de 32% com valor preditivo positivo de 22,7% e valor preditivo negativo de 80%. Conclusão: Em desacordo com a literatura, o índice de CD64 se mostrou inadequado para prever a positividade de hemocultura nesta população específica de pacientes com neutropenia febril. O valor linear da PCR também não foi capaz de prever a positividade dos culturais nos neutropênicos febris. Deste modo, ambos os exames não são adequados para prever positividade de culturais em crianças neutropências febris.Introduction : One in every 25 children with cancer will die from therapy complications: it means one in six deaths. Between these patients, a major cause of death remains infection. This condition often presents as fever with neutropenia, better known as “febrile neutropenia." Early recognition of infectious processes in neutropenic patients is hampered by the fact that these may have dissimilar and non-specific clinical presentations, pending the onset of fever to start treatment with antibiotics. The CD64 is a neutrophil surface marker, detectable by flow cytometry tests, and are not expressed in non-sensitized neutrophils. When the neutrophil is exposed to TNF-alpha and other inflammatory mediators, it is activated and is measured via the CD64 index. Rationale: The early diagnosis of sepsis with positive blood culture in febrile neutropenic children is of utmost importance. Laboratory tests available help us little in the moment this patient arrives at the hospital. The early diagnosis of a bacterial infection in these patients allows a better management of antibiotic therapy and, consequently, an improvement in survival. Objectives: The main objective of this paper is to evaluate the existence of a relationship between the index value of CD64 on the first day of febrile neutropenia with positive blood culture. The correlation with other parameters such as leukocyte count, CRP and ESR was also evaluated. Methodology: This is a cases-control, prospective, diagnosis study that included 64 episodes of neutropenia. The cases group(n=14) was defined by those with positive blood cultures and the control(n=50) one with negative blood cultures. Because it is a non - parametric variable, we used the Mann-Whitney correlation test to relate the index of CD64 with the result of blood culture in each group and with the other variables. A ROC (Receiver Operating Characteristic) curve was used to assess the competence of the CD64 index to predict the outcome of blood culture. The median rate of CD64 in the case group was 2,1 (±3,9) and controls for the group was 1,76(±5,02). The Mann-Whitney tests were not able to show the relationship between the value of CD64 index and the results of blood cultures. The CD64 index was also not correlated with the positivity of CRP. The ROC curve did not show that the CD64 index was able to predict the positivity of blood culture. Regarding efficacy measurmements, sensibility was 64,3%, specificity 42%, positive predictive value 23,7% and negative predictive value 80%. The linear value of CRP showed no statistically significant difference between the groups of blood cultures. For CRP, the efficacy measurements were sensibility 71,4%, specificity 32%, positive predictive value 22,7% and negative predictive value 80%. Conclusion: CD64 index was not suitable to predict the positivity of blood cultures in this specific population of patients with febrile neutropenia. Also the linear values of CRP showed no statistically significant difference between the blood culture groups. Therefore, both exams should not be used in order to predict positivity of cultural in neutropenic febrile childen.
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Sánchez, Lombardi Ignacio Ándres. "Monitorización individualizada de amikacina en pacientes con neutropenia febril." Tesis, Universidad de Chile, 2018. http://repositorio.uchile.cl/handle/2250/168510.
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Grado de magíster en farmacologíaIntroducción: La neutropenia febril es la reacción adversa (RAM) más severa de los agentes quimioterapéuticos y que predispone a los pacientes con cáncer a infecciones graves1, siendo esencial la administración rápida de antimicrobianos.7-8 Las recomendaciones nacionales e internacionales incluyen el uso de aminoglucósidos.1,5-10 Sin embargo, para asegurar un correcto resultado, esta terapia antibiótica requiere una adecuada monitorización. En esta investigación, se pretende establecer el tiempo más adecuado de monitorización de amikacina en pacientes con neutropenia febril, para asegurar un régimen posológico seguro y eficaz que contribuya al manejo y recuperación de estos pacientes. Objetivo: Determinar el esquema más adecuado para monitorizar amikacina en pacientes con neoplasias y otras patologías hematológicas, que cursan con neutropenia febril en un hospital de alta complejidad, que es centro de referencia de pacientes hematoncológicos. Metodología: Se realizó un estudio prospectivo aleatorizado doble ciego, que comparó dos estrategias de monitoreo plasmático: uno mediante la toma de nivel en valle, contra uno a las 12 horas posterior al término de la infusión. Ambos grupos se caracterizaron y analizaron según sus parámetros farmacocinéticos y el cumplimiento de los parámetros Farmacocinético/Farmacodinámico (FC/FD), evaluándose además la correlación e influencia de ciertos factores como el clearence de amikacina y creatinina. Para el cálculo del régimen posológico de amikacina como indicación médica, se utilizó un modelo farmacocinético teórico del programa TDMS2000®. Resultados: Se incluyó un total de 42 pacientes, de los cuales 21 comprendieron a los que se les monitorizó en valle. El 81,0% de los pacientes que se les monitorizó en valle tuvieron niveles < 1, de los cuales 38,1% fueron en cero, en el caso de la monitorización a las 12 horas sólo en 9,5% tuvieron niveles < 1. Al individualizar las dosis hubo un aumento de 15 a 19 mg/Kg, siendo así el 85,7% de los pacientes cumplieron el Cmáx/CIM ≥ 8 en ambos grupos. Sin embargo, en el caso del ABC/CIM > 70, sólo 14,3% de los pacientes con niveles valle cumplieron con el parámetro objetivo versus aquellos que se les midió niveles a las 12 horas que fue un 42,3%, presentando diferencia estadística significativa. En el caso de la seguridad ningún paciente presentó disfunción renal en ambos grupos, objetivándose en 21 días de tratamiento. Por otra parte, se encontró una correlación directa entre el clearence de creatinina y el de amikacina. Conclusión: Finalmente, se puede concluir que la monitorización de amikacina a las 12 horas cuando se utiliza un programa farmacocinético con modelación bayesiana, es un método más adecuado y efectivo que la monitorización valle en el cumplimiento FC/FD. La monitorización farmacocinética de amikacina es un método seguro en la prevención de nefrotoxicidad en tratamientos prolongados.
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Perazzoli, Camila. "Estudo das afecções abdominais e anorretais em pacientes hematológicos neutropênicos febris. Análise da casuística, fatores de risco para mortalidade e proposta de escore de gravidade." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-08012019-155704/.
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Introdução. Pacientes neutropênicos febris, particularmente os portadores de doenças hematológicas, podem ter como causa de sua descompensação clínica afecções abdominais e anorretais. O acompanhamento do quadro infeccioso é motivo de angústia para o cirurgião coloretal, pois a literatura sobre o tema é restrita e quadros oligosintomáticos eventualmente evoluem para óbito em curto espaço de tempo. Objetivos. Descrever, estratificar e comparar com a literatura a casuística de pacientes hematológicos neutropênicos febris com foco abdominal ou anorretal identificado. Estudar o risco absoluto e relativo de mortalidade de algumas variáveis associadas com a condição. Propor um escore de gravidade das afecções abdominais e anorretais em pacientes hematológicos neutropênicos febris. Materiais e Métodos. Trata-se de um estudo a partir da análise retrospectiva de 897 prontuários médicos de pacientes internados para as equipes de Hematologia e Transplante Células Tronco Hematopoéticas, no Hospital de Clínicas da Universidade de São Paulo, Ribeirão Preto-SP, entre os anos de 2008-2013. Foram elegíveis para o estudo 74 episódios de neutropenia febril com foco infeccioso abdominal ou anorretal, ocorridos em 69 pacientes. Após coletadas as características a respeito da amostra, foram estratificados os dados, comparados com a literatura sobre o tema, realizados os cálculos de medidas de efeito e análise estatística. Por fim, considerando os resultados obtidos, a experiência clínica dos autores e critérios de plausibilidade biológica comum, foram selecionados cinco aspectos como sendo os principais preditores de mortalidade hospitalar em pacientes hematológicos neutropênicos febris, com afecção abdominal ou anorretal. Resultados. O escore proposto demonstrou possuir mortalidade crescente conforme o quadro se agrava e a pontuação se eleva (teste exato de Fischer: 0,001). Ao considerar o modelo logístico de probabilidade de óbito por nível do escore, o valor encontrado AUC foi de 0,82 (0,72-0,925) e o valor de Estatística de Hosmer-Lemeshow de 2,3, com p=0,806. Discussao. Os escores contribuem na prática clínica diária para a tomada objetiva de decisões. De forma semelhante ao escore APACHE e seus refinamentos, o sistema prognóstico proposto possui variáveis de fácil acesso e traduz de maneira satisfatória o comportamento e a confiabilidade dos resultados obtidos, através da AUC>0,8 e estatística de Hosmer-Lemeshow com p> 0,05. Conclusão. O sistema de escore proposto permite predizer a chance de óbito durante a internação em pacientes neutropênicos febris com afeccção abdominal ou anorretal. Novos estudos sobre o tema são necessários e o escore proposto necessita e deve ser validado em uma amostra maior e distinta de pacientes.Introduction. Febrile neutropenic patients, particularly those with haematological diseases, may have abdominal and anorectal conditions as a cause of their clinical decompensation. The follow-up of the infectious condition is a cause of distress for the colorectal surgeon, because the literature on the subject is restricted and oligosymptomatic conditions can lead to death within a short period of time.Goals. To describe, stratify and compare with the literature the casuistry of febrile neutropenic haematological patients with abdominal or anorectal focus identified. To study the absolute and relative risk of mortality of some variables associated with the condition. To propose a severity score of abdominal and anorectal conditions in neutropenic hematologic febrile patients. Materials and Methods. This is a study based on the analysis of 897 medical records of inpatients for hematology and hematopoietic stem cell transplantation (HSCT) teams at the Hospital de Clínicas of the University of São Paulo, Ribeirão Preto-SP, between the years of 2008-2013. A total of 74 episodes of febrile neutropenia with infectious abdominal or anorectal conditions occurred in 69 patients. After collecting the characteristics regarding the sample, the data were stratified, compared to the literature on the subject, the calculations of effect measures and statistical analysis were performed. Finally, considering the results obtained, the author\'s clinical experience and criteria of common biological plausibility, five aspects were selected as the main predictors of hospital mortality in febrile neutropenic haematological patients with abdominal or anorectal disease. Results. The proposed score showed an increasing mortality rate as the condition worsens and the score rises (Fischer\'s exact test: 0.001). When considering the logistic model of death probability by level of the score, the AUC value found was 0.82 (0.72-0.925) and the Hosmer-Lemeshow statistic value was 2.3, with p = 0.806. Discussion. The scores contribute to daily clinical practice for objective decision making. Similar to the APACHE score and its refinements, the proposed prognostic system has easily accessible variables and satisfactorily translates the behavior and reliability of the results obtained through AUC> 0.8 and Hormer-Lemeshow statistics with p> 0,05. Conclusion. The proposed score system allows predicting the chance of death during hospitalization in febrile neutropenic patients with abdominal or anorectal disease. New studies on the subject are necessary and the proposed score needs and must be validated in a larger and different sample of patients.
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Graham, Emily Nicole. "Optimizing Care for Oncologic and Hematologic Patients with Febrile Neutropenia." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1483522367955844.
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Trucchia, Rosana Edith. "Modelo predictivo de bacteriemia en pacientes neutropénicos febriles." Doctoral thesis, Trucchia RE. Modelo predictivo de bacteriemia en pacientes neutropénicos febriles [Internet]. Universidad Nacional de Córdoba; 2015 [citado el 14 de febrero de 2020]. Disponible en: https://rdu.unc.edu.ar/handle/11086/6173, 2015. http://hdl.handle.net/11086/6173.
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Tesis - Doctor en Medicina y Cirugía - Universidad Nacional de Córdoba. Facultad de Ciencias Médicas, 2015
161 h. : graf.Fil: Trucchia, Rosana Edith. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.
La neutropenia febril (NF) es la complicación más frecuente del tratamiento quimioterápico en los pacientes con cáncer. Es considerada una emergencia médica. La atención de los enfermos debe ser pronta y conveniente para contribuir a la disminución de la mortalidad. Como objetivos se propuso: 1) identificar distintos grupos de pacientes según factores de riesgo y la enfermedad neoplásica; 2) conocer la microbiología local de las infecciones; 3) relacionar los diferentes citostáticos con la evolución de los episodios; 4) elaborar un modelo predictivo de riesgo de bacteriemia; 5) sistematizar el tratamiento antimicrobiano empírico; 6) desarrollar una pauta de manejo inicial regionalizada. El trabajo se realizó en el Instituto Oncológico Universitario del Hospital Nacional de Clínicas de Córdoba. Se incluyeron los pacientes con diagnóstico de NF secundaria a quimioterapia y enfermedades neoplásicas y que fueran internados. Criterios de inclusión: recuento de neutrófilos en sangre circulante <0,5 x 109/L ó <1,0 x 109/L con predicción de descenso a <0,5 x 109/L en las siguientes 24 horas y con temperatura axilar > a 38 °C. Se los dividió en un grupo retrospectivo (140 pacientes, desde 01/01/00 al 31/12/08) y otro prospectivo (36 pacientes, desde 01/01/09 al 31/12/10). Los datos disponibles fueron organizados en una planilla de cálculo Excel y luego procesados con el software SPSS 17. En una primera etapa, se realizó un análisis descriptivo univariado, completado con un análisis multivariado utilizando las técnicas de correspondencias múltiples y conglomerados. Para detectar asociaciones entre las variables se usaron pruebas estadísticas de Chi Cuadrado. Se reclutaron 280 pacientes (hombres 56 %, mujeres 44 %), las neoplasias hematológicas prevalecieron en ambos grupos (75 %). Predominaron las bacteriemias por cocos Gram positivos (42 %) en el primer grupo y por bacilos Gram negativos (46 %) en el segundo. E. coli fue el germen más aislado, con elevado porcentaje de sensibilidad a amikacina, piperacilinatazobactam y carbapenems.
Febrile neutropenia (FN) is the most common complication of chemotherapy in cancer patients. It is considered a medical emergency. The patient must be attended soon and conveniently to decrease the risk of death. The objectives proposed were: 1) identify different groups of patients according to the risk factors and the neoplastic disease; (2) know the local microbiology of infections; (3) link the cytostatics to the episodes evolution; (4) develop a predictive model of risk related to bacteremia; (5) systematize the empirical antimicrobial treatment; (6) develop a regionalized initial guideline of management. The study was conducted in the University Cancer Institute of the National Hospital of Clinics in Córdoba (Argentina). It included patients with diagnosis of NF secondary to chemotherapy and neoplastic diseases. Inclusion criteria: neutrophil count in peripheral blood <0,5 x 109/L o <1,0 x 109/L with prediction of descent to <0,5 x 109/L in the next 24 hours and axillary temperature > 38 °C. They were divided into a retrospective group (140 patients, from 01/01/00 to 31/12/08) and a prospective one (36 patients, from 01/01/09 to 31/12/10). Available data were organized in a form of Excel spreadsheets and then processed with the software SPSS 17. In a first stage, a univariate descriptive analysis was performed, and then it was completed with a multivariate analysis using multiple correspondence and cluster techniques. Chi square statistical tests were used to detect associations between variables. 280 patients (56 % men, 44 % women) were recruited, the hematological disease predominated in both groups (75 %). Gram positive cocci bacteremia (42 %) predominated in the first group and Gram negative bacilli (46 %) in the second. E. coli was the most isolated germ, with high percentage of sensitivity to amikacin, piperacillin-tazobactam and carbapenems.
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Aguilar, Lourdes Soledad, and Nuria Flores. "Conocimiento enfermero sobre manejo inicial del paciente pediátrico oncohematológico con neutropenia febril." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2016. http://bdigital.uncu.edu.ar/8649.
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El niño enfermo de cáncer recibe, durante su tratamiento, antineoplásicos, los cuales bajan sus defensas exponiéndolo a adquirir distintas patologías. Esto, en términos científicos, se denomina neutropenia, que es la reducción del número de neutrófilos circulantes. La fiebre en el paciente neutropénico es el primer signo de infección y deberá ser debidamente tratada, ya que las infecciones no tratadas tienen una elevada mortalidad, y en consecuencia la iniciación del tratamiento antibiótico de amplio espectro debe ser precoz. Es necesario que en las instituciones hospitalarias se desarrollen protocolos para la atención del paciente oncohematológico con neutropenia febril al momento del ingreso al hospital con el fin de brindar tratamiento inmediato y de calidad. Es de suma importancia el rol del enfermero en cuanto a cuidados, conocimientos y la aplicación efectiva de dicho protocolo. Este trabajo de investigación tiene como objetivo determinar si los conocimientos que poseen los enfermeros del Hospital Pediátrico Dr. Humberto Notti sobre los protocolos de atención de los pacientes oncohematológicos con neutropenia febril son los adecuados para lograr una atención integral de los mismos. La muestra fue de 64 enfermeros de una población de 128 de todos los servicios con que cuenta el hospital, durante el primer semestre de 2016 los que respondieron una encuesta estructurada con preguntas cerradas.Fil: Aguilar, Lourdes Soledad. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Flores, Nuria. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
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Tarvydienė, Diana. "Vaikų, sergančių onkohematologinėmis ligomis, žemos infekcijos rizikos grupės nustatymas febrilinės neutropenijos metu." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2011~D_20140627_170111-63916.
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Kraujo vėžys ar/ir intensyvi chemoterapija taikoma sergantiems vaikams sumažina organizmo atsparumą infekcijai. Viena iš pagrindinių infekcinio proceso priežasčių yra gydymo eigoje išsivystanti neutropenija, kurią dažniausiai lydi karščiavimas. Karščiavimą pacientams gali sukelti tiek taikoma chemoterapija, tiek beprasidedantis infekcinės kilmės uždegimas, todėl labai svarbu kuo anksčiau nustatyti karščiavimo priežastį, tuo būdu išvengiant empirinio plataus spektro antibiotikų skyrimo sergantiems vaikams ir iš to išplaukiančių pasekmių – ilgesnės hospitalizacijos ir su tuo susijusios gyvenimo kokybės blogėjimo, rezistentiškos mikrofloros išsivystymo, pavojaus užsikrėsti antibiotikams astparia hospitaline infekcija. Todėl labai svarbu klinikinėje praktikoje turėti jautrius ir specifinius imunologinius žymenis, kurių pagalba vaikus su febriline neutropenija būtų galima priskirti žemai infekcinio susirgimo rizikos grupei, tuo būdu išvengiant nereikalingo antibiotikų vartojimo ir ilgalaikės hospitalizacijos. Šio darbo tikslas – įvertinti infekcinio proceso ir imuninio atsako sąlygojamus žymenų (citokinų, ūmios fazės baltymų) pokyčius infekcinio proceso pradžioje, siekiant nustatyti vaikų, sergančių onkohematologinėmis ligomis žemos infekcijos rizikos grupę. Tiriamąją grupę sudaro 45 onkohematologiniai pacientai su febriline neutropenija 2009 - 2010 metais besigydžiusių Vilniaus Universiteto Vaikų ligoninės onkohematologijos skyriuje. Išanalizuoti 66 febrilinės neutropenijos... [toliau žr. visą tekstą]Blood cancer and/or related intensive chemotherapy may cause decreased host defense against infection. One of the key factors of infections process is treatment related neutropenia that is accompanied by fever. Patient with chemotherapy – related neutropenia and fever are usually hospitalized and treated on empirical intravenous broad – spectrum antibiotic regimen. Early diagnosis of sepsis in children with febrile neutropenia remains difficult due to non – specific clinical and labaratory signs of infection. Therefore it is very important in clinical practice have a sensitive and specific immunological marker, which helps children with febrile neutropenia attributed to the low risk of infectious disease, thereby avoiding unnecessary use of antibiotics and long – term hospitalization. The objective was to evaluate the process of infection and immune response driven markers ( cytokines,acute phase proteins) changes in the early infections process in order to identify children with low – infection risk group, suffering from oncohematological diseases. The target group consists of fourtyfive oncohematology patient with febrile neutropenia which were treated in Vilniaus University hospital of chidren, from 2009 – 2010. Were analyzed the sixtysix epizodes of febrile neutropenia. According to clinical and microbiological parameters were divided into low risk and high risk groups. Low – risk group included patients with fabrile episodes, a negatyve blood culture and the absence of... [to full text]
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Thornton, James Eric Jr, and James Eric Jr Thornton. "Optimizing Detection of Clinically Relevant Microbes from Whole Blood of Febrile Neutropenia Patients." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626343.
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Febrile Neutropenia is a potentially fatal side effect of cancer chemotherapy. Weakened immune systems make FN patients vulnerable to infection by a wide range of opportunistic pathogens. Culture-positive rates in these patients is notoriously low. Treatment consists of broad-spectrum antibiotics that are often ineffective in treating the patient and may be harmful in some cases. The advancement of sequencing technology and the decrease in associated costs suggests an imminent shift from culture to molecular based diagnostics. Described here is a streamlined bioinformatics workflow for analyzing whole genome shotgun reads from blood in 6 Febrile Neutropenia and 5 bone marrow transplant patients. To ensure that taxonomic assignments are accurate, binary mixtures of bacteria (with varying taxonomic distance across a log-scale of abundance) and a mock bacterial community in known staggered abundance were sequenced and subjected to the bioinformatics workflow. Reported are the effects of using various bioinformatics steps, strategies, and parameters to establish standard protocols for the expanded use of NGS for analyzing clinical samples. Quality control using modest parameters resulted in significant reductions in total number of reads ranging from 38% to 57% and showed bias in removing viral reads. Host screening against the human genome removed 42% to 96% of reads from NF samples, including Human Parvovirus B19 an endogenous microbe in the human genome representing a potentially causative organism. Time series analysis of bone marrow transplant samples revealed the dynamic nature of microbial communities and identified growing systemic infection of Escherichia coli. Consistent presence of contaminating organisms including Human Endogenous Virus and Cutibacterium acnes was observed in samples with few total microbial sequences, compared to samples with potentially causative organisms with a higher abundance of microbial reads. Taken together, this work lays the foundation for bioinformatics pipelines that use open-source software, require minimal computational resource, and provide rapid and accurate identification of known microorganisms.
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Martins, Renata Eiras. "Avaliação do risco de complicações decorrentes de neutropenia febril em pacientes tratados no Instituto do Câncer do Estado de São Paulo." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5155/tde-29102014-160517/.
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INTRODUÇÃO: Neutropenia febril (NF) é frequente complicação quimioterapia para tumores sólidos e é de suma importância a identificação dos pacientes de alto risco para o seu desenvolvimento. OBJETIVOS: Caracterização clínica, laboratorial e dos fatores de risco para NF em pacientes admitidos para antibioticoterapia. MATERIAL E MÉTODOS: Estudo retrospectivo de todos os pacientes consecutivamente internados com NF no ICESP (Instituto do Câncer do Estado de São Paulo) entre maio de 2008 e maio de 2012. Critérios de inclusão: idade >= 16 anos, diagnóstico de NF (temperatura axilar >= 37,8ºC e neutrófilos < 500/mm3 ou entre 500-1000/mm³ com tendência à queda) em pacientes portadores de tumor sólido. Dados clínico-laboratoriais e de evolução foram coletados; realizada análise univariada e multivariada a fim de investigar a relação entre os fatores de risco e o desenvolvimento de complicações. RESULTADOS: 333 episódios de NF em 295 pacientes com tumores sólidos foram avaliados. Idade mediana de 57 anos (16-88), 150 do sexo feminino (51%). Os sítios primários das neoplasias mais frequentes foram mama (15%), pulmão (14%), sarcomas (13%), colorretal (10%), estômago (9%), cabeça e pescoço (8%) e testículo (5%). 31 pacientes (10%) apresentaram mais de um episódio de NF. À admissão, a mediana de contagem de neutrófilos foi 690/mm3, e a mediana de MASCC atribuído 19 (7-26). Sítios de infecção mais comumente identificados foram pulmão (19%), trato urinário (15%), corrente sanguínea (13%), abdominal (10%) e partes moles (8%); quanto à etiologia, bacilos Gram-negativos isolados em 36 (11%) episódios e cocos Gram-positivos em 15 (9%). Mediana de internação de 10 dias (0-106 dias). Alguma complicação grave foi identificada em 248 (74%) episódios, sendo que hipotensão (47%), admissão em UTI (35%), insuficiência renal (30%), insuficiência respiratória (19%) e alteração do estado mental (17%) as mais comuns (> 10%). A mortalidade foi 14% (46 pacientes). A análise univariada revelou como fatores de risco para complicações idade >= 60 anos (OR 3.1, 95%CI 1.75-5.47, p 0.0001), controle sistêmico da neoplasia (OR 0.51, 95%CI 0.31-0.85, p 0.01), DPOC (OR 4.45, CI95% 1.71 - 11.54, p 0.0016), presença de sintomas ao diagnóstico (OR 2.16, CI95% 1.26-3.69, p 0.0063), desidratação (OR 4.63, CI95% 2.57-8.31, p<0.0001) e regular ou mau estado geral (OR 3.31, CI95% 1.93-5.68, p<0.0001). Na análise multivariada, permaneceram como fatores de risco a desidratação (OR 3.7, CI95% 2.09-6.78, p 0.000009), DPOC (OR 3.7, CI 95% 1.27-11.04, p 0.0166) e idade >= 60 anos (OR 2.5, CI95% 1.37-4.58, p 0.0029). O modelo multivariado corretamente classificou os episódios como de alto risco em 75% dos eventos. Elaboramos um novo escore de risco baseado nos valores de OR, onde pacientes desidratados receberam quatro pontos, aqueles com DPOC três pontos e aqueles com idade >= 60 anos, dois pontos. O escore final corresponde à soma das parcelas acima. Consideramos os pacientes como de alto risco com escore > 5 pontos (sensibilidade 72%, especificidade 64%). CONCLUSÕES: Complicações clínicas graves são comuns durante os episódios de NF, em pacientes com tumores sólidos. DPOC, idade >= 60 anos e desidratação representam fatores de risco para o desenvolvimento de complicações. Um novo escore de fácil execução foi proposto, o qual deverá ser validado prospectivamenteBACKGROUND: Febrile neutropenia (FN) is a frequent complication during chemotherapy in solid tumors, and to identify those patients (pts) with higher risk of developing complications during FN episodes is important. Here we aimed to characterize those risk factors for severe complications during FN episodes in pts with solid tumors, admitted for intravenous antibiotics. MATERIAL AND METHODS: It is a retrospective study of all consecutive pts admitted with FN at ICESP (Instituto do Câncer do Estado de São Paulo) between May/2008 and May/2012. Eligibility criteria included: age >= 16y, the diagnosis of FN (documented axillary temperature greater than 37.8°C, and neutrophil count < 500/mm3 or expected to fall below 500/mm3) as an adverse event of chemotherapy for a solid tumor. Potentially life-threatening complications during FN episodes were collected and univariate and multivariate logistic regression analyses were performed to assess the relationship between risk factors and these complications. RESULTS: 333 FN episodes in 295 pts with solid tumors were studied. Median age was 57 y (16-88), 150 female (51%). Most frequent primary sites included: breast (15%), lung (14%), bone/soft tissues (13%), colorectal (10%), stomach (9%), head & neck (8%) and testis (5%). 31 pts (10%) presented more than 1 FN episode. At admission, median neutrophil count was 690/mm3, and the median MASCC score was 19 (7-26). Infection sites were identified as pulmonary (19%), urinary tract (15%), bloodstream (13%), abdominal (10%) and soft tissues (8%), and regarding etiology, Gram-negative bacilli could be isolated in 36 (11%) and Gram-positive cocci in 15 FN episodes (9%). All pts were admitted with a median duration of hospital stay of 10 d (0-106 d). Overall, a severe complication as a consequence of FN was detected in 248 episodes (74%), being hypotension (47%), ICU admission (35%), renal failure (30%), respiratory failure (19%) and altered mental state (17%) the most common (> 10%), and 46 pts died (14%). A univariate analysis revealed age >= 60y (OR 3.1, 95%CI 1.75-5.47, p 0.0001), controlled cancer (OR 0.51, 95%CI 0.31-0.85, p 0.01), previous COPD (OR 4.45, CI95% 1.71 - 11.54, p 0.0016), presence of symptoms (OR 2.16, CI95% 1.26-3.69, p 0.0063) or dehydration (OR 4.63, CI95% 2.57-8.31, p < 0.0001) and regular or bad general condition (OR 3.31, CI95% 1.93-5.68, p < 0.0001) as risk factors for complications. On multivariate analysis, only dehydration (OR 3.7, CI95% 2.09-6.78, p 0.000009), previous COPD (OR 3.7, CI 95% 1.27-11.04, p 0.0166) and age >= 60y (OR 2.5, CI95% 1.37-4.58, p 0.0029) were associated with severe complications. The multivariate model correctly classified 75% of all FN episodes as complicated. We elaborated a new risk score based on the OR, where dehydrated pts scored 4 points, those with COPD 3 points and those with age >= 60y 2 points. The final score was calculated by the sum of all above. We have considered as high risk pts those who scored > 5 points (sensitivity 72%, specificity 64%). CONCLUSIONS: Severe complications were common during febrile neutropenic episodes in pts with solid tumors. COPD, age >= 60 y and dehydration represent clinically significant risk factors for severe complications in FN pts. A new score was proposed, though it should be prospectively validated
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Salinas, Campusano Sebastián Alejandro. "Identificación precoz de gérmenes fúngicos y bacterianos mediante el uso de Multiplex PCR en pacientes con neutropenia febril." Tesis, Universidad de Chile, 2010. http://repositorio.uchile.cl/handle/2250/140610.
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Memoria para optar al título de BioquímicoLa incidencia de infecciones nosocomiales en pacientes oncológicos inmunodeprimidos es entre 2 y 10 veces superior al de otros grupos de pacientes. Entre las infecciones nosocomiales, las bacterias y hongos oportunistas son de particular interés debido a su influencia en la morbilidad, mortalidad y costos terapéuticos asociados a este grupo de pacientes. El tiempo que demora el laboratorio en determinar el agente que causa el cuadro infeccioso es crítico dado que permite un tratamiento específico, y por ende una mayor tasa de éxito. Usando técnicas microbiológicas tradicionales, se detecta el agente infeccioso sólo en el 20- 40% de los casos con procedimientos que requieren de al menos 3 días. Esta memoria propone utilizar la técnica de biología molecular Múltiplex PCR para obtener un diagnóstico concluyente en 5 horas. Nuestro sistema de diagnóstico permite la detección in vitro simultánea y rápida de los patógenos oportunistas que frecuentemente causan estados de neutropenia febril en pacientes oncológicos, por lo que esta memoria evaluará la capacidad del sistema montado para detectar estos patógenos en muestras clínicas. De resultar exitoso este estudio, impactaremos beneficiosamente la rapidez con la que se podrá tomar una decisión terapéutica informada y mejoraremos la expectativa de vida de pacientes inmunodeprimidos
The incidence of nosocomial infections in immunocompromised cancer patients is between 2 and 10 times higher than other groups of patients. Among the nosocomial infections, opportunistic bacteria and fungi are of particular interest because of their impact on morbidity, mortality and treatment costs associated with this group of patients. The time taken for the laboratory to determine the agent causing the infection is critical because it allows a specific treatment and therefore a higher rate of success. Using traditional microbiological techniques, the infectious agent is detected only in 20- 40% of patients with procedures that require at least three days. This thesis proposes to use the technique of molecular biology technique of Multiplex PCR to obtain a conclusive diagnosis in 5 hours. Our diagnostic system allows simultaneous detection and rapid in vitro detection of opportunistic pathogens that frequently cause states of febrile neutropenia in cancer patients. In this work will evaluate the ability of our Multiplex PCR system to detect these pathogens in clinical samples. If this results successful, we will produce a positive impact on the speed with which physicians may take informed treatment decisions and improve the life expectancy of immunosuppressed patients
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Sugiura, Shiro. "Asymptomatic C-reactive protein elevation in neutropenic children." Kyoto University, 2017. http://hdl.handle.net/2433/226006.
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Zuckermann, Joice. "Avaliação da implantação do "protocolo assistencial de manejo da neutropenia febril" no HCPA." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2006. http://hdl.handle.net/10183/8473.
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Morgan, Jessica. "Safely shortening the duration of hospitalisation in children and young people with febrile neutropenia." Thesis, University of York, 2016. http://etheses.whiterose.ac.uk/16690/.
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Febrile neutropenia is the commonest life-threatening complication of treatment for children with cancer. Though the majority of children have no significant complications associated with its occurrence, current management includes intravenous antibiotics and in-patient care. Reduced therapy regimes for children at low risk of complications may have benefits for families and the National Health Service. This thesis aimed to answer two main questions: In children and young people with low risk febrile neutropenia, are reduced therapy regimes safe, effective and acceptable to key stakeholders? What factors are involved in decision-making about acceptability of early discharge regimes? Given the complexity of the research problem, the work utilised a mixed methods approach, selecting appropriate methodologies for each aspect of the problem and then combining results to provide a nuanced consideration of this multifaceted topic. Three sequential phases were performed, each informing and developing the next, whilst simultaneously allowing deeper interpretation of findings in earlier phases. Phase one, a quantitative systematic review, provided safety and treatment failure rates relating to reduced therapy regimes, whilst phase two, a qualitative synthesis, presented an interpretive account of experiences of early discharge. Phase three involved a focus group study exploring experiences and perceptions of key stakeholders involved in febrile neutropenia care in the United Kingdom. Following mixing of phases in both design and interpretation stages, the thesis found that reductions in therapy are associated with increased readmission rates, but not increased risk of serious adverse events. It exposed the previously underestimated harms of febrile neutropenia admissions and the paternalistic nature of decision making. Increasing shared decision making through discussing risks, developing mutual trust and negotiating control is necessary to achieve individualised treatment and improve experiences for stakeholders. The thesis outlines aspirations for future care of these children and young people and proposes various actions to achieve these goals.
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Krack, Andrew T. "Leukopenia and Neutropenia as Predictors for Serious Bacterial Infections in Febrile Infants 60 Days and Younger." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1627658704260617.
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Schwarzbold, Alexandre Vargas. "Modelagem de um escore de mielotoxicidade quimioterápica na predição de neutropenia febril em tumores hematológicos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2006. http://hdl.handle.net/10183/16362.
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A neutropenia induzida pela quimioterapia é o mais comum efeito adverso da quimioterapia sistêmica para o câncer e é frequentemente complicada por neutropenia febril (NF). O uso profilático de fatores de crescimento hematopoiéticos pode reduzir o risco, a severidade e a duração da NF. Na prática clínica atual, a decisão de administrar ao paciente profilaxia com fatores de crescimento é baseada principalmente no potencial mielotóxico dos esquemas de QT, mas riscos específicos dos regimes não são definidos. Em muitos estudos, a toxicidade da quimioterapia é analizada em termos de alta dosagem versus baixa dosagem, sem uma regra geral que considere os diferentes esquemas de QT em uma única escala. O objetivo desse estudo é validar uma classificação de toxicidade de um esquema de QT e avaliar sua utilidade em um modelo de predição de risco de neutropenia febril em pacientes com câncer hematológico no começo de um ciclo de quimioterapia. Foram avaliados prospectivamente duzentos e sessenta e oito pacientes e acompanhados durante 1053 ciclos de quimioterapia na Bélgica, entre 2001 e 2005. Informações relevantes foram coletadas no começo do primeiro ciclo e o número de dias de neutropenia febril foi contabilizado no acompanhamento dos pacientes [dicotomizada (sem neutropenia versus >= dia de NF)]. A relação entre o desfecho e as co-variáveis foi analisada usando a Equação de Estimativa Generalizada (GEE). Um regime de quimioterapia agressiva é o maior preditor de NF [razão de chances (OR) 5.2 (3.2-8.4)]. Os outros preditores independentes são: doença subjacente, o comprometimento de medula óssea, superfície corporal <= 2m², uma contagem pré-tratamento de monócitos <150µl e a interação entre o primeiro ciclo na mesma linha de tratamento e uma dosagem de hemoglobina pré-tratamento. Usando as estimativas dos coeficientes de regressão, uma regra de predição clínica de NF foi desenvolvida com essas características: sensibilidade 78.6%, especificidade 62.3%, valor preditivo positivo de 42.7%% e um valor preditivo negativo de 89.1%. Estudos posteriores são necessários para validar esse escore bem como investigar novos potenciais fatores com o intuito de melhor prever a NF.Chemotherapy-induced neutropenia is the most common adverse effect of chemotherapy and is often complicated by febrile neutropenia (FN). As prophylactic use of colonystimulating factors (CSF) can reduce the risk, severity, and duration of FN, it is of great importance to identify as soon as possible after or even before the start of chemotherapy, the patients who will develop FN. In the current clinical practice, the decision to give to the patient a colony-stimulating factor (CSF) prophylaxis is mainly based on the myelosuppressive potential of the chemotherapy regimen. The objective of this study is to validate a classification of aggressiveness of a chemotherapy regimen and to evaluate its usefulness in a risk prediction model of FN in patients with hematological cancer at the beginning of a chemotherapy cycle. Two hundred and sixty-six patients were prospectively enrolled and followed during 1053 cycles. Relevant patient informations were collected at the beginning of the first cycle and the number of days of FN were counted in the follow-up [dichotomized (no FN versus>= 1 day of FN)]. Aggressive chemotherapy regimen is the major predictor of FN [odds ratio 5.2 (3.2 - 8.4)]. The other independent predictors are the underlying disease, an involvement of bone marrow, body surface<= 2m², a baseline monocyte count <150/µl and the interaction between the first cycle in the same treatment line and a baseline hemoglobin dosage. A rule of prediction of FN was computed with these characteristics: sensitivity 78.6%, specificity 62.3%, positive predictive value 42.7% and negative predictive value 89.1%. Further studies are needed to validate this score.
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LE, CALVEZ PHILIPPE. "Approche clinique et therapeutique du patient granulopenique febrile." Nantes, 1993. http://www.theses.fr/1993NANT033M.
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Rosa, Regis Goulart. "Impacto da aderência ao programa de controle de antimicrobianos na mortalidade de pacientes com neutropenia febril." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/53148.
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Terapia empírica com antimicrobiano de amplo espectro faz parte do manejo inicial padrão de pacientes com neutropenia febril (NF). Evidências suficientes de quais esquemas antibióticos devem ser inicialmente prescritos já existem; embora, nenhum estudo randomizado tenha avaliado se a aderência a programas de controle de antimicrobianos (PCAs) resulta em diminuição das taxas de mortalidade por esta síndrome. No presente estudo de coorte prospectivo, realizado em um hospital terciário no período de outubro de 2009 a agosto de 2011, avaliou-se o impacto da aderência ao PCA, aferida através da prescrição antimicrobiana inicial, na mortalidade em 295 episódios de NF (em 145 indivíduos adultos) que necessitaram de tratamento endovenoso hospitalar. Após análise multivariada através de regressão de Cox, incluindo outros preditores de mortalidade, a aderência ao PCA mostrou-se fator de proteção independente para morte 28 dias após início do episódio de NF (razão de hazard ajustada[HR], 0.29; intervalo de confiança de 95% [IC 95%], 0.11 a 0.72). Os fatores de risco encontrados para a não-aderência ao PCA foram presença de hipotensão (risco relativo ajustado[RR], 1.90; IC 95%, 1.37 a 2.63), diarreia (RR, 2.13; IC 95%, 1.66 a 2.73), dor perianal (RR, 2.08; IC 95%, 1.54 a 2.82), suspeita de foco infeccioso em cavidade oral (RR, 2.45; IC 95%, 1.75 a 3.43) e manifestações cutâneas de infecção (RR, 2.34; IC 95%, 1.81 a 3.04). A escolha antimicrobiana inicial é particularmente importante no manejo inicial do paciente com febre em vigência de neutropenia; a aderência ao PCA, que preconiza o uso racional de antibióticos, mostrou ser efetiva na redução de mortalidade durante o curso da doença. A presença de fatores modificadores da terapia inicial representa risco para não-adesão ao programa de controle de antimicrobianos.Empirical therapy with broad-spectrum antimicrobial is part of the initial management of patients with febrile neutropenia (FN). Enough evidence on which antibiotics schemes should be initially prescribed already exists; however, no randomized study has evaluated whether adherence to antimicrobial stewardship programs (ASPs) results in lower rates of mortality from this syndrome. In the present prospective cohort study performed in a tertiary hospital, from October 2009 to August 2011, we evaluated the impact of adherence to ASP, measured by initial antimicrobial prescribing, in mortality of 295 episodes of FN (in 145 adults) that required intravenous inpatient treatment. After multivariate analysis through Cox regression, including other predictors of mortality, adherence to ASP proved to be an independent protective factor for death 28 days after the beginning of the episode of FN (adjusted hazard ratio [HR], 0.29; 95% confidence interval [95% CI], 0.11 to 0.72). The risk factors found to noncompliance to ASP were presence of hypotension (adjusted relative risk [RR], 1.90; 95% CI, 1.37 to 2.63), diarrhea (RR, 2.13; 95% CI, 1.66 to 2.73), perianal pain (RR, 2.08; 95% CI, 1.54 to 2.82), suspected source of infection in oral cavity (RR, 2.45; 95% CI 1.75 to 3.43) and cutaneous manifestations of infection (RR, 2.34; 95% CI, 1.81 to 3.04). The choice of antimicrobial is particularly important in the initial management of patients with fever in the presence of neutropenia; the adherence to ASP, which calls for rational use of antibiotics, was effective in reducing mortality during the course of the disease. The presence of signs or symptoms that demand changes in the initial therapy poses risks to nonadherence to the antimicrobial management program.
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Bossaer, John B. "Incidence and Treatment of Vancomycin-Resistant Enterococci (VRE) Infection in VRE Colonized Febrile Neutropenic Patients." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/2338.
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Bossaer, John B. "Incidence and Treatment of Vancomycin-Resistant Enterococci (VRE) Infection in VRE Colonized Febrile Neutropenic Patients." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/2362.
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BOISDRON, PATRICK. "Antibiotherapie ambulatoire empirique et par voie orale, de premiere intention, chez le sujet neutropenique febrile." Angers, 1991. http://www.theses.fr/1991ANGE1054.
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Bossaer, John B., Philip D. Hall, and Eliabeth Garrett-Mayer. "Incidence of Vancomycin-Resistant Enterococci (vre) Infection in High-Risk Febrile Neutropenic Patients Colonized with Vre." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/2315.
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Purpose: This study seeks to determine the incidence of vancomycin-resistant enterococci (VRE) infection in high-risk neutropenic fever patients colonized with VRE and to determine patient characteristics associated with VRE infection.
Methods: We conducted a retrospective, single-center, unmatched case-control study. Fifty-three VRE-colonized, high-risk patients with neutropenic fever were identified between January 2006 and February 2009. The two most common diagnoses/conditions included acute myeloid leukemia and hematopoietic stem cell transplantation. Data collected included days of neutropenia, days of fever, demographic data, culture results, and antimicrobial therapy.
Results: Twenty of the 53 patients (38%) with VRE colonization developed a VRE infection. The most common VRE infections were bacteremias (26%). The presence of neutropenia lasting longer than 7 days was associated with the development of VRE infection in this high-risk population colonized with VRE. The timeframe to develop VRE infection varied from 1 day to 2 weeks.
Conclusion: For patients colonized with VRE, approximately 38% of high-risk neutropenic patients developed a VRE infection. This is the first study to specifically evaluate the incidence of VRE infections in febrile neutropenic patients colonized with VRE. Future research into the use and efficacy of empiric VRE coverage is needed.
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DORE, DELBIAUSSE VERONIQUE. "Antibiotherapie empirique au cours des neutropenies severes febriles apres chimiotherapie ; a propos de deux etudes comparatives chez 280 malades." Lyon 1, 1990. http://www.theses.fr/1990LYO1M037.
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Hansson, Emma K. "Pharmacometric Models for Biomarkers, Side Effects and Efficacy in Anticancer Drug Therapy." Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-170738.
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New approaches quantifying the effect of treatment are needed in oncology to improve the drug development process and to enable treatment optimization for existing therapies. This thesis focuses on the development of pharmacometric models for biomarkers, side effects and efficacy in order to identify predictors of clinical response in anti-cancer drug therapy. The variability in myelosuppression was characterized in six different cytotoxic anticancer treatments to evaluate a model-based dose individualization approach utilizing neutrophil counts as a biomarker. The estimated impact of inter-occasion variability was relatively low in relation to the inter-individual variability, indicating that myelosuppression is predictable from one treatment course to another. The approach may thereby be useful for dose optimization within an individual. To further study and to identify predictors for the severe side effect febrile neutropenia (FN), the relationship between the shape of the myelosuppression time-course and the probability of FN was characterized. Patients with a rapid decline in neutrophil counts and high drug sensitivity were identified to have a higher probability of developing FN compared with other patients who experience grade 4 neutropenia. Predictors of clinical response in patients receiving sunitinib for the treatment of gastro-intestinal stromal tumor (GIST) were identified by the development of an integrated modeling framework. Drug exposure, biomarkers, tumor dynamics, side effects and overall survival (OS) were linked in a unified structure, and univariate and multivariate exposure variables were tested for their predictive capacities. The soluble biomarker, sVEGFR-3 and tumor size at start of treatment were found to be promising predictors of overall survival, with decreased sVEGFR-3 levels and smaller baseline tumor size being predictive of longer OS. Also hypertension and neutropenia was identified as predictors of OS. The developed modeling framework may be useful to monitor clinical response, optimize dosing in sunitinib and to facilitate dose individualization.
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Fitzgerald, Sarah E. M. D. "A Meta-Analysis of the Diagnostic Performance of Procalcitonin in the Diagnosis of Serious Bacterial Infection in Pediatric Febrile Neutropenia." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342544799.
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Massaro, Karin Schmidt Rodrigues. "Comparação entre os biomarcadores inflamatórios procalcitonina (PCT), interleucina-6 (IL-6) e proteína-C reativa (PCR) para diagnóstico infeccioso e evolução de febre em pacientes neutropênicos submetidos a transplante de células tron." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-27092013-141901/.
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Introdução: No presente estudo foram avaliados biomarcadores na ocorrência de febre em pacientes neutropênicos após transplante de células tronco hematopoiéticas (TCTH). Objetivo: O objetivo principal foi avaliar os valores séricos de biomarcadores: proteína C reativa (PCR), procalcitonina (PCT) e IL-6 (interleucina-6) que possam identificar precocemente infecção em TCTH. Outro objetivo foi fatores de risco para óbito nessa população. Métodos: Os biomarcadores foram avaliados em um estudo prospectivo que incluiu 296 pacientes neutropênicos, submetidos a TCTH autólogo ou alogênico. Os biomarcadores PCT, PCR e IL-6 foram dosados nos seguintes momentos:dia da neutropenia constatada sem febre, evento febril ou hipotermia (T < 35ºC), 24 h após a febre ou hipotermia, 72 horas após a febre ou hipotermia e febre prolongada ou seja 48 horas após a coleta no momento anterior ou na persistência da febre, cinco dias após a coleta no momento anterior. Os dados clínicos e laboratoriais, foram avaliados até a evolução para alta ou o óbito, em uma planilha Excel® 2003 e foram processados pelos programas SPSS e STATA. Os pacientes foram classificados nos seguintes grupos (I- afebril; II- febre de origem indeterminada FOI e III- febre clinica ou microbiologicamente comprovada) em relação a cada marcador estudado (PCT, PCR e IL-6). Foram feitos cálculos para estabelecer área sob a curva ROC, sensibilidade, especificidade, para avaliação da febre e óbito. Para avaliar o desfecho óbito foi realizada análise multivariada com regressão logística stepwise. Resultados: Dos 296 pacientes, 190 apresentaram febre. Duzentos e dezesseis (73%) foram submetidos a transplantes autólogos e 80 (27,0%) alogênicos. Dos 80 casos de TCTH alogênicos 74 (92,6%) eram aparentados e apenas 6 (7,4%) aparentados. Dos 80 casos alogênicos 69 (86,3%) eram fullmatch e 11(13,7%) mismatch. Em relação aos grupos já citados acima, temos a seguinte distribuição: grupo I: 106 pacientes (35,8%); grupo II: 112 pacientes (37,8%) e grupo III: 78 (26,4%). Os valores de média e mediana da IL-6 no momento afebril no grupo I em relação ao grupo II (p = 0,013), apresentando valor significativamente maiores. Os níveis da PCR no grupo I diferiram de forma significativa dos encontrados no grupo III (p < 0,05). Os grupos diferiram em relação aos níveis de IL-6 e de PCR no momento febril. O grupo II apresentou concentrações de IL-6 e de PCR significativamente menores que o grupo III. Os melhores valores de corte de PCT para os momentos de coleta: febre, 24 horas após a febre, 72 horas de febre, e febre prolongada foram respectivamente: 0,32; 0,47; 0,46 e 0,35?g/L. No momento da febre a sensibilidade foi 52,3 e a especificidade 52,6 para o diagnóstico de infecção. Os melhores valores de corte de PCR para os momentos de febre, 24 horas após, 72 horas após e febre prolongada foram, respectivamente: 79, 120, 108 e 72 mg/L. No momento da febre a sensibilidade foi 55,4 e especificidade foi 55,1. Os melhores valores de corte de IL-6 para os momentos de febre, 24 h após, 72 horas após a febre e febre prolongada foram respectivamente: 34, 32, 16 e 9 pg/mL. A sensibilidade e especificidade no momento da febre foram respectivamente: 59,8 e 59,7. Na análise dos três biomarcadores no grupo de pacientes autólogos, verifica-se que só a IL-6 apresenta valores significativos nos momentos iniciais (afebril, febre e 24 horas após a febre). Os seguintes fatores de risco independentes foram identificados na análise multivariada: doador aparentado, doador não aparentado, infecção por Gram-negativo, DHL >= 390 (UI/L), ureia >= 25 (mg/dL) e PCR >= 120 (mg/L). Conclusões: IL-6 e PCR têm associação com diagnóstico precoce de infecção clinica ou microbiologicamente confirmada em neutropenia febril após TCTH. A associação dos três marcadores não apresentou nenhuma vantagem, e não melhorou a acurácia diagnóstica. A IL-6 foi o único biomarcador significativamente associado de forma precoce com infecção quando avaliado apenas pacientes submetidos a TCTH autólogos As variáveis independentes associadas com óbito foram: transplante alogênico, infecção por Gram-negativos, DHL >= 390UI/L no momento da febre e ureia >= 25 mg/dL no momento da febre e PCR >= 120 (mg/L)Introduction: In the present study, biomarkers were assessed in the occurrence of fever in neutropenic patients upon hematopoietic stem cell transplantation (HSCT). Objective: The main objective was to assess the serum values of biomarkers: C-reactive protein (CRP), procalcitonin (PCT) and IL-6 (interleukin-6) which can early identify infection in HSCT. Another objective was risk factors for death in that population. Methods: The biomarkers were assessed in a prospective study which comprised 296 neutropenic patients submitted to autologous or allogeneic HSCT. The biomarkers PCT, CRP and IL-6 were dosed at the following moments: day of afebrile neutropenia, febrile event or hypothermia (T < 35ºC), 24 h upon fever or hypothermia, 72 hours upon fever or hypothermia and long-standing fever, that is, 48 hours upon the last sampling or at fever persistence, five days upon the last sampling. The clinical and laboratory data were assessed up to the evolution to discharge or death, in an Excel® 2003 spreadsheet and were processed by the SPSS and STATA software. Patients were classified in the following groups (I- afebrile; II- fever of unknown origin FUO and III- clinically or microbiologically proven fever) in regard to each biomarker studied (PCT, CRP and IL-6). Calculations were made to establish the area under the ROC curve, sensitivity, specificity, for the assessment of the evolution and death. In order to assess the death outcome, a multivariate analysis with stepwise logistic regression was conducted. Results: Out of the 296 patients, 190 had fever. Two hundred and sixteen (73%) were submitted to autologous transplantations and 80 (27.0%) to allogeneic ones. Out of the 80 cases of allogeneic HSCT, 74 (92.6%) were related and only 6 (7.4%) were unrelated. Out of the 80 allogeneic cases, 69 (86.3%) were fullmatch and 11(13.7%) were mismatch. In regard to the groups mentioned above, we have the following distribution: group I: 106 patients (35.8%); group II: 112 patients (37.8%) and group III: 78 patients (26.4%). The mean and median values of IL-6 at fever onset in group I in regard to group II (p = 0.013), presenting significantly higher values. The levels of CRP in group I differed significantly from those found in group III (p < 0.05). The groups differed in regard to the levels of IL-6 and CRP at fever onset. Group II presented IL-6 and CRP concentrations significantly lower than group III. The best cut-off values of PCT for sampling: fever onset, 24 hours upon fever, 72 hours of fever, and long-standing fever were, respectively: 0.32; 0.47; 0.46 and 0.35?g/L. At fever onset, sensitivity was 52.3 and specificity 52.6 for infection diagnosis. The best cut-off values of CRP for fever onset, 24 hours upon fever, 72 hours upon fever and long-standing fever were, respectively: 79, 120, 108 and 72 mg/L. At fever onset, sensitivity was 55.4 and specificity was 55.1. The best cut-off values of IL-6 for fever onset, 24 hours upon fever, 72 hours upon fever and long-standing fever were, respectively: 34, 32, 16 and 9 pg/mL. At fever onset, sensitivity and specificity were, respectively: 59.8 and 59.7. In the analysis of the three biomarkers in the group of autologous patients, it is observed that only IL-6 presents significant values at initial moments (afebrile, fever and 24 hours upon fever). The following independent risk factors were identified in the multivariate analysis: related donor, unrelated donor, Gram-negative infection, DHL >= 390 (UI/L), urea >= 25 (mg/dL) and CRP>=120 (mg/L). Conclusions: IL-6 and CRP are associated to the early diagnosis of clinically or microbiologically confirmed infection in post-HSCT febrile neutropenia. The association of the three biomarkers did not present any advantage, nor did it improve diagnostic accuracy. IL-6 was the only biomarker significantly associated at an early stage with infection when assessed only in patients submitted to autologous HSCT. The independent variables associated with death were: allogeneic transplantation, Gram-negative infection, DHL >= 390UI/L at fever onset and urea >= 25 mg/dL at fever onset and PCR >= 120 (mg/L)
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Talbot, Marc Robert. "Why people in haematological and oncological care avoid or delay seeking medical treatment for infections caused by low white blood cell counts." Thesis, University of Exeter, 2012. http://hdl.handle.net/10036/3836.
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This article reports the findings of a grounded theory study of the processes involved in adherence and treatment seeking delay for febrile neutropenia in chemotherapy patients. Interviews were conducted with 12 patients. Six theoretical constructs were generated, namely ‘Recall of Treatment Advice’, ‘Impact of Emotions’, ‘Influence of Social Networks’, ‘Symptom Monitoring Behaviour’, ‘Symptom Interpretation’, and ‘Preparation and Journey Time’. A model was developed to reflect the complex interplay between these theoretical constructs. Data extracts are presented to illustrate the grounding of the model in patients’ accounts, and the model is discussed with reference to previous theory and research.
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Phillips, Robert Stephen. "Optimizing risk predictive strategies in febrile neutropenic episodes in children and young people undergoing treatment for malignant disease." Thesis, University of York, 2014. http://etheses.whiterose.ac.uk/6571/.
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The aim of this thesis was to investigate the clinical problem of the initial management of febrile neutropenia (FN) in children and young people undergoing treatment for malignant disease, to thoroughly evaluate the existing research, and to collect and synthesise this to quantify the risk of adverse clinical outcomes, through development of develop a new risk prediction model, using individual participant data (IPD). A further aim was to develop methodological approaches to IPD analysis in the development of predictive models, including the graphical display and communication of such information. The research produced five systematic reveiws of the existing medical literature in this area, and helped create a global collaboration of 19 research groups (PICNICC) which has shared data on over 5000 episodes of FN. This individual patient data was synthesised using hierarchical logistic regression meta-analysis to develop a new predictive model for MDI, which is robust to internal validation techniques (bootstrapping and leave-one-out cross-validation). The multivariable predictive model derived had six components: Tumour type, temperature, clinical description of being “severely unwell”, and the results of measurements of three elements of the full blood count: haemoglobin concentration, total white cell count and absolute monocyte count. It showed good overall fit (Brier[scaled] 4.5% discordancy), moderate discrimination (AU-ROC 0.736) and good calibration between predicted and actual estimates of the risk of MDI (calibration slope 0.95). We have demonstrated that such a data sharing project is feasible across many different jurisdictions and eras of study, and we now need to undertake a series of further projects to evaluate the model and go on to improve the management of paediatric FN across the world.
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Schütz, Malte [Verfasser]. "Prospektive Kohortenstudie zur Erfassung und Evaluation von febriler Neutropenie, Infektherden und antimikrobieller Therapie bei Patienten mit Lymphomen / Malte Schütz." Ulm : Universität Ulm, 2019. http://d-nb.info/1191267261/34.
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Lafferrerie, Chris. "Evaluation de la tazocilline en monothérapie comme antibiothérapie empirique de première ligne au cours des neutropénies fébriles chez l'adulte suivi pour hémopathie maligne." Bordeaux 2, 1999. http://www.theses.fr/1999BOR2M045.
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Gelatti, Ana Caroline Zimmer. "Descri??o do perfil epidemiol?gico e dos desfechos de pacientes com suspeita de neutropenia febril secund?ria ao tratamento oncol?gico em setor de emerg?ncia de um hospital terci?rio." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2017. http://tede2.pucrs.br/tede2/handle/tede/8205.
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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Background: Cancer is one of the three leading causes of death in Brazil, and one of the most prevalent diseases in our country. Febrile neutropenia is a febrile syndrome associated with a reduction in neutrophil count and a frequent complication of systemic cancer treatment. Febrile neutropenia may affect up to 40% of cancer patients. Considering the large number of patients stricken by febrile neutropenia, and the risk that inadequate management imposes on patients' lives, standardization of care and the early identification of a high-risk population is key to improving clinical outcomes. Guidelines for treatment of febrile neutropenia universally recommend immediate start of antibiotic therapy (<60 minutes). Objective and Methods: The goal of this retrospective study was to evaluate the epidemiological profile and clinical outcomes of patients treated with chemotherapy or radiotherapy who met criteria for febrile neutropenia and required a visit to the emergency department of a tertiary hospital. Results: A total of 212 patients with cancer presented with fever and required an emergency room evaluation between September 2014 and August 2016. Of these, 68 met criteria for febrile neutropenia. Hematologic neoplasms were associated with an increased risk of neutropenia [OR = 3,41 (95%, CI: 1,52-7,65) p = 0,003] when compared to solid tumors. Seven (10.3%) patients with neutropenia were treated on an outpatient setting and 61 (89,7%) were admitted. The median time to onset of the antibiotic was 140 minutes. Of the patients admitted to the hospital, 47 (77,0%) were discharged from hospital and 14 (23,0%) died. The median of the Multinational Association for Supportive Care in Cancer (MASCC) score was statistically higher in the group that was discharged when compared to the group that died (23,5 versus 14,5 points), with an OR=0,69 [(95%, CI: 0,51-0,94) p = 0,017]. Conclusion: This analysis corroborates previously published data supporting that febrile neutropenia is a potential morbidity and mortality factor in cancer patients. Strategies that aim to qualify the care of patients at higher risk in the emergency room is essential to reduce mortality rates.
Introdu??o: O c?ncer ? uma das tr?s principais causas de morte no Brasil, destacando-se como uma das doen?as mais prevalentes em nosso meio. A neutropenia febril ? uma s?ndrome febril associada a redu??o na contagem do n?mero de neutr?filos, sendo uma complica??o frequente do tratamento oncol?gico sist?mico, com taxas de preval?ncia que podem atingir at? 40%. Tendo em vista o grande n?mero de pacientes oncol?gicos acometidos pela neutropenia febril, e o risco que o seu manejo inadequado imp?e ? vida dos doentes, a padroniza??o da assist?ncia e a identifica??o precoce de uma popula??o de alto risco ? fundamental para melhorarmos os desfechos cl?nicos. As diretrizes de tratamento da neutropenia febril universalmente recomendam o in?cio imediato de antibioticoterapia (<60 minutos). Objetivo e M?todos: O objetivo do presente estudo ? avaliar, de forma retrospectiva, o perfil epidemiol?gico e os poss?veis desfechos cl?nicos de pacientes com neutropenia febril tratados com quimioterapia ou radioterapia que procuraram a emerg?ncia de um hospital terci?rio. Resultados: Um total de 212 pacientes oncol?gicos foram avaliados por febre entre Setembro de 2014 e Agosto de 2016. Destes, 68 apresentavam neutropenia febril. Neoplasias hematol?gicas foram associadas a um maior risco de neutropenia [OR = 3,41 (IC 95%: 1,52-7,65) p = 0,003], quando comparados com tumores s?lidos. Sete (10,3%) pacientes com neutropenia foram tratados a n?vel ambulatorial e 61 (89,7%) a n?vel de interna??o hospitalar. A mediana de tempo para in?cio do antibi?tico foi de 140 minutos. Dos pacientes tratados a n?vel de interna??o, 47 (77,0%) receberam alta hospitalar e 14 (23,0%) evolu?ram para ?bito. A mediana do escore ?Multinational Association for Suportive Care in Cancer? (MASCC) foi estatisticamente superior no grupo que recebeu alta hospitalar quando comparado com o grupo que evolui para ?bito (23,5 versus 14,5 pontos), com OR=0,69 (IC 95% 0,51 - 0,94) e p=0,017. Conclus?o: Esta an?lise corrobora dados previamente publicados, refor?ando que a neutropenia febril ? potencial fator de morbimortalidade em pacientes oncol?gicos. Estrat?gias que possam qualificar o atendimento de pacientes de maior risco nos setores de emerg?ncia ? fundamental para reduzir as taxas de mortalidade.
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Fiusa, Maiara Marx Luz 1987. "Avaliação clínica de proteínas modeladoras da permeabilidade endotelial como biomarcadores para estratificação de risco na sepse em pacientes com neoplasias hematológicas e neutropenia febril." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309165.
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Orientador: Erich Vinicius de PaulaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A neutropenia febril (NF) em pacientes com neoplasias hematológicas é caracterizada pelo alto risco de sepse e choque séptico. Embora a utilização de escores clínicos como o MASCC permita a identificação de pacientes de baixo risco, este escore é menos informativo em pacientes de alto risco, onde se encaixam a maioria dos pacientes com neoplasias hematológicas, além daqueles submetidos a esquemas intensivos de quimioterapia. Ao mesmo tempo, a aplicação de biomarcadores de gravidade como a procalcitonina, validados em pacientes não-neutropênicos, é controversa em pacientes com NF. A quebra da barreira endotelial é um elemento chave no choque séptico, de modo que proteínas envolvidas neste processo são candidatos atrativos como biomarcadores de gravidade na sepse. Neste estudo, avaliamos prospectivamente o valor da dosagem de VEGF-A, sFlt-1, Ang-1 e Ang-2 como biomarcadores da evolução para choque séptico em 120 pacientes com NF. Pacientes internados nas enfermarias de Hematologia e Transplante de Medula Óssea do HC da UNICAMP para tratamento de NF entre março de 2011 e 2012 foram convidados a participar. As amostras foram coletadas na manhã seguinte à entrada no estudo, junto com a coleta de exames de rotina. O estudo foi desenhado com o objetivo de mimetizar as condições de coleta e processamento das amostras, que seriam encontradas na prática clínica real. Foi avaliada a evolução para choque séptico e mortalidade em 28 dias. Os resultados foram comparados com marcadores de prognóstico clássicos como proteína C reativa, e escores MASCC e SOFA. No total, 99 pacientes preencheram os critérios de inclusão, dos quais 19,8% evoluíram com choque séptico. Não foram observadas diferenças clínicas e demográficas entre os pacientes com NF não-complicada e choque séptico, exceto pelo escore SOFA, significativamente mais elevado no segundo grupo. Os níveis de VEGF-A e sFlt-1 foram semelhantes entre os dois grupos. Em contraste, os níveis séricos de Ang-2 estavam aumentados em pacientes com choque séptico, ao passo que os níveis séricos de Ang-1 estavam diminuídos. Considerando o papel antagônico destas angiopoietinas na regulação da permeabilidade endotelial, a relação Ang-2/Ang-1 foi calculada, como indicador de desequilíbrios na concentração destes moduladores, que pudessem indicar um estado mais ou menos propenso à queda da barreira endotelial. De fato, um aumento na relação Ang-2/Ang-1 foi encontrada em pacientes com choque séptico (5,29 - variação de 0,58 a 57,14) em relação aos pacientes com NF não-complicada (1,99 - variação de 0,06 a 64,62; P=0,01). Na análise univariada e multivariada, a relação Ang-2/Ang-1 provou ser um fator de risco independente para o desenvolvimento de choque séptico e mortalidade em 28 dias. Desta forma, concluímos que a elevação dos níveis séricos de Ang-2 e da relação Ang-2/Ang-1 está associada ao risco aumentado de choque séptico e mortalidade em pacientes com NF, mesmo quando coletada sob condições próximas àquelas encontradas a prática clínica
Abstract: Febrile neutropenia (FN) in patients with hematologic malignancies is characterized by a high risk of sepsis complications and septic shock. Although the use of clinical scores such as the MASCC allows the identification of low-risk patients, this score is much less informative in high-risk patients, a category in which most patients with hematologic malignancies, and those undergoing intensive chemotherapy regimens, fit in. At the same time, the use of classical biomarkers such as procalcitonin in non-neutropenic patients is controversial in patients with FN. Endothelial barrier breakdown is a key element in septic shock, so that proteins involved in this process are attractive candidates as biomarkers of sepsis severity. In this study, we prospectively evaluated the value of VEGF-A, sFlt-1, Ang-1 and Ang-2 serum levels as biomarkers of progression to septic shock in 120 patients with FN. Patients hospitalized in the Hematology and Bone Marrow Transplantation in-patient units of a university hospital (HC-UNICAMP) for the treatment of FN between March 2011 and March 2012 were invited to participate. Samples were collected in the following morning after study entry, along with the collection of routine labs. The study was designed to mimic the conditions of blood sample collection and processing that would be encountered in "real-world" clinical practice. Clinical outcomes were (1) progression to septic shock and (2) death within 28 days from fever onset. Results were compared with classical prognostic markers such as C-reactive protein, and MASCC and SOFA scores. In total, 99 patients met the inclusion criteria, of which 19.8% progressed to septic shock. No differences clinical and demographic differences were observed between patients with uncomplicated-FN or septic shock, except for a higher SOFA scores in the latter group. Levels of VEGF-A and sFlt-1 were similar between the two groups. In contrast, serum levels of Ang-2 were increased in patients with septic shock, whereas serum levels of Ang-1 were decreased in these patients. Considering the antagonistic role of angiopoietins 1 and 2 in regulating endothelial permeability, the Ang-2/Ang-1 ratio was calculated as an indicator of imbalances in the concentration of these modulators. In fact, a high Ang-2/Ang-1 ratio was found in patients with septic shock (5.29 - range 0.58 to 57.14) compared to patients with uncomplicated FN (1.99 - range 0.06 to 64.62, P = 0.01). In univariate and multivariate analysis, the Ang-2/Ang-1 ratio proved to be an independent risk factor for the development of septic shock and for 28-day sepsis-related mortality. Thus, we concluded that a high Ang-2/Ang-1 ratio is associated with increased risk of septic shock and mortality in patients with FN, even when collected under conditions close to those encountered in real-world clinical practice
Mestrado
Clinica Medica
Mestra em Ciências
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Faria, Henrique Pereira. "Contribuições da tomografia computadorizada de alta resolução do tórax na fase precoce da neutropenia febril pós-quimioterapia, Santa Casa de Belo Horizonte, 2006-7." Universidade Federal de Minas Gerais, 2008. http://hdl.handle.net/1843/ECJS-7K6QFX.
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To determine the prevalence of lung findings suspected of infections in the early phase of neutropenic fever and analyze the associate risk factors, a transversal study was conducted at the oncology and radiology services of the Hospital Santa Casa de Belo Horizonte. Ethical approval was obtained from the institutional review board and informed consent was required. The study included 31 high resolution computed tomography studies performed in 26 neutropenic patients induced by chemotherapy with fever for less than 72 hours despite empiric antibiotic treatment from April 2005 to April 2006. All patients had normal chest radiographs. The high resolution computed tomography images were assessed for the presence and distribution of ground-glass opacities, nodules, consolidations, tree-in-bud patterns and halo sign and reviewed by three experienced independently radiologists. Agreement between observers was determined by the kappa test. Univariate statistical analysis of the risk factors was performed using Fishers exact and Mann- Whitney tests with a p value of less than 0,05 was considered statistically significant. Later a multivariate analysis was made using the CART tree. Overall, 11 (35%) of 31 high resolution computed tomography scans demonstrated abnormalities. Ground-glass opacities were present in 7 patients (63, 6 %), nodules in 6 (54, 5 %), focal consolidations in 4 (36, 3 %), three-in-bud pattern in 2 (18 %) and halo sign in 1 (9 %). Statistical analysis identified the presence of mucositis as an independent factor of absence of pulmonary abnormalities (p=0,001). The present study showed a high prevalence of suspected infections high resolution computed tomography findings in neutropenic patients with fever for less than 72 hours and normal chest radiographs. The incidences of pulmonary anormalities were similar in different groups except for patients without mucositis. These data suggest that high resolution computed tomography should be considered in the initial assessment of patients with fever and neutropenia, especially individuals without mucositis.Com o objetivo de determinar a prevalência de achados pulmonares suspeitos de infecção na fase precoce da neutropenia febril e analisar os fatores de risco associados, um estudo transversal foi conduzido nos Serviços de Oncologia e Radiologia da Santa Casa de Belo Horizonte. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e todos os pacientes estavam de acordo com o termo de consentimento livre e esclarecido. Foram incluídos 31 estudos de tomografia computadorizada de alta resolução realizada em 26 pacientes neutropênicos induzidos por quimioterapia e febris há menos de 72 horas, apesar de antibioticoterapia empírica, entre abril de 2006 e abril de 2007. Todos os pacientes tinham exames radiológicos convencionais de tórax normais. As imagens de tomografia computadorizada de alta resolução foram avaliadas quanto à presença e distribuição das opacidades em vidro-fosco, nódulos, consolidações, padrões de árvore em brotamento e sinal do halo e foram revistas por três experientes radiologistas independentemente. Concordância entre os observadores foi determinada pelo teste de Kappa. Análise estatística univariada dos fatores de risco foi realizada pelo teste exato de Fischer e pelo teste de Mann-Whitney, e um valor de p < 0,05 foi considerado estatisticamente significativo. Posteriormente, uma análise multivariada foi realizada utilizando o algoritmo CART. Das 31 tomografias computadorizadas de alta resolução realizadas, 11 (35%) apresentaram anormalidades. Opacidades em vidro-fosco estavam presentes em 07 pacientes (63,6%), nódulos em 06 (54,5%), consolidações focais em 04 (36,3%), padrões de árvore em brotamento em 02 (18%) e sinal do halo em 01 (9%). Análise estatística identificou a ausência de mucosite como um fator independente da presença de anormalidades pulmonares (p = 0,001%). O presente estudo mostrou uma alta prevalência de achados suspeitos de infecção na tomografia computadorizada de alta resolução em pacientes com febre há menos 72 horas e exame radiológico convencional de tórax normal. As incidências de anormalidades pulmonares foram similares em diferentes grupos, exceto para pacientes sem mucosite. Esses dados sugerem que a tomografia computadorizada de alta resolução deve ser considerada na evolução inicial de pacientes com febre e neutropenia, especialmente em indivíduos sem mucosite.
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Sasse, Emma Chen. "Fatores estimuladores de colonia na prevenção da neutropenia febril induzida pela quimioterapia em crianças com leucemia linfoblastica aguda : revisão sistematica da literatura ate abril 2002." [s.n.], 2003. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312075.
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Orientador : Silvia Regina BrandaliseDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: RAZÕES: A mielossupressão e conseqüente neutropenia febril, causadas pela quimioterapia intensiva no tratamento da leucemia linfoblástica aguda (LLA) pediátrica são complicações graves e de alto risco. Os fatores estimuladores de colônias (FEC) são citoquinas usadas para elevar o número de neutrófilos circulantes e reduzir as complicações decorrentes da neutropenia, apesar de não haver consenso sobre seu uso em crianças na literatura. Existem alguns estudos randomizados com resultados conflitantes quanto ao benefício dos FEC nestes pacientes. A falta de dados conclusivos provenientes de estudos conflitantes exige a realização de uma revisão sistemática da literatura sobre o uso profilático dos FEC. MÉTODOS: Revisão sistemática da literatura que incluiu estudos randomizados com desenho paralelo, comparando o uso de FEC versus placebo ou observação em crianças com LLA em quimioterapia não ablativa. A pesquisa englobou bases de dados computadorizados (MEDLINE@,EMBASE@, LILACS@, CANCERLIT@,BIBLIOTECA COCHRANE@), pesquisa manual em periódicos especializados, procura pelas referências dos artigos e consulta a especialistas sobre trabalhos em andamento. A metanálise foi realizada utilizando o software Review Manager 4.1. Dados dicotômicos foram analisados usando Odds Ratio de Peto (OR) e os dados contínuos foram analisados usando a diferença ponderada entre as médias (DPM). RESULTADOS: No total, 5463 referências foram analisadas, onde treze estudos foram localizados e destes, seis estudos preencheram os critérios de inclusão com um total de trezentos e trinta e dois pacientes. Cento e sessenta e um deles foram randomizados para o grupo FEC e cento e setenta e um para o grupo controle (placebo ou observação). Na metanálise, o uso de FEC reduziu o tempo de hospitalização [DPM: -3,44, IC 95% -4,76 a -2,12; p< 0,00001], diminuiu o atraso na quimioterapia em 19% [OR=0,4, IC 95%: 0,18 a 0,89; p=0,03] e os episódios de infecção em 12% [OR= 0,46; IC 95% 0,26 a 0,82; p=0,009]. A metanálise para avaliar episódios de neutropenia febril mostrou uma tendência ao benefício do uso de FEC, mas não atingiu o nível de significância de 5% [OR=0,57; IC 95%: 0,31 a 1,05; p=0.07]. Um efeito significante para o grupo tratado com FEC foi detectado no tempo de duração de neutropenia [DPM= -3,44; IC 95%: -4,76 a -2,12; p<0,00001]. Dados sobre mortalidade global, efeitos colaterais e duração de antibioticoterapia endovenosa não puderam ser combinados na metanálise. CONCLUSÃO: O uso de FEC não traz beneficios significativos na redução de episódios de neutropenia febril em crianças com LLA em quimioterapia intensiva. Porém estes pacientes podem se beneficiar do uso de FEC reduzindo o tempo de hospitalização, diminuindo o atraso na quimioterapia e reduzindo episódios de infecção. Porém, os estudos eram de curta duração na maioria das vezes e não existe consenso quanto à dose ideal de FEC. Existe a necessidade de novos estudos controlados de longa duração para elucidar estas questões e determinar a segurança do FEC na LLA pediátrica
Abstract: Acute lymphoblastic leukemia (ALL) represents about 30% of hematologic malignancies in the childhood. Chemotherapy induced febrile neutropenia in these patients is a frequent event and it is the most feared side effect as it is potentially a life threatening situation. The current treatment is supportive care plus antibiotics. Colony-stimulating factors are cytokines that stimulate and accelerate the production of one or more cellular lineages in bone marrow and some of these has been tested in clinical trials as additional therapy to prevent febrile neutropenia in children with ALL, but the results are conflicting. Systematic review will provide the most reliable assessment and the best recommendations for practice. Objectives: To evaluate the safety and effectiveness of the addition of G-CSF or GM-CSF to prevent the chemotherapy induced febrile neutropenia in children with acute lymphoblastic leukemia. Search strategy The search covered the principal electronic databases: CANCERLIT, EMBASE, LILACS, MEDLINE, SCI and The Cochrane Controlled Clinical Trials Database. Experts were consulted and references ftom the relevant articles were also scanned. Selection criteria. We searched for all Randomised Controlled Trials (RCT) that compared CSF versus placebo or no treatment prior to installation of chemotherapy-induced febrile neutropenia in children with ALL. Data collection & analysis Two of the reviewers selected, critically appraised and extracted data of the studies independently. The end points of interest were number of febrile neutropenia episodes, length of neutropenia, length of hospitalization, delay of chemotherapy, number of infections, length of antibiotics use, side effects, and mortality. A meta-analysis of these end points were performed and the results were expressed as Peto's odds ratio and for continuous outcomes we calculated a weighted mean difference and a standardized mean difference. Main results More than 5000 references were screened and 6 studies were included. The number of febrile neutropenia episodes was not influenced by the use of CSF [OR=0.57; CI 95%=0.31 to 1.05; p=0.07]. The group ofpatients treated with CSF had a shorter length of neutropenia [WMD=-3.44; CI 95%=-4.76 to -2.12; p<0.00001]but this result was highly influenced by one study. The use of CSF showed significant benefit for reducing the length of hospitalization, [WMD=-1.58; CI 95%= -3 to -0.15; p=0.03] and treatment delays [OR=0.4;CI 95%=0.18 to 0.89; p=0.03]. Conclusion Children with ALL that use CSF have a shorter length of hospitalization and less episodes of treatment delays. But a possible effect on the incidence of febrile neutropenia and the time to neutrophil recovery were not clear
Mestrado
Pediatria
Mestre em Saude da Criança e do Adolescente
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Batista, Marjorie Vieira. "Aspergilose invasiva em pacientes imunodeprimidos: comparação entre as provas de galactomanana, 1,3 betaD-glucana, dados tomográficos e desfecho clínico." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-18062015-105032/.
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A aspergilose invasiva (AI) é a infecção por fungos filamentosos mais comum em pacientes imunodeprimidos, especialmente em transplantes de células tronco hematopoiético e neoplasias hematológicas. Objetivo: Geral: Estabelecer a comparação entre a dosagem de Galactomanana (GM), 1,3betaD-glucana (BDG) e dados tomográficos no diagnóstico da AI bem como seu papel no desfecho clínico. Específicos: 1. Verificar a sensibilidade e especificidade dos ensaios de Galactomanana e de 1,3betaD-glucana no soro e lavado broncoalveolar. 2. Comparar os resultados da galatomanana e 1,3betaD-glucana com os dados de imagem em pacientes com suspeita de AI. 3. Verificar a relação entre a evolução dos níveis de GM e desfecho clínico (óbito e sobrevida). Casuística, Materiais e Métodos: Realizou-se um estudo tipo coorte prospectiva, incluindo 398 sujeitos das diversas enfermarias de pacientes imunodeprimidos do HCFMUSP, sendo incluídos dois grupos de pacientes: 202(51%) AI e 198(49%) controles. Resultados: Dos casos, 18 (8,8%) tinham aspergilose provada, 28 (13,7%) provável e 158 possível (77,5%), de acordo a classificação de 2002 EORTC/MSG (European Organization for Research and Treatment of Cancer / Mycoses Study Group). Os sujeitos submetidos ao TCTH eram 42,7%, com neoplasias hematológicas 37%, TOS 9% e outras doenças 11,3%. Os fatores de risco associados ao desenvolvimento da AI foram neutropenia, monocitopenia, uso de corticóide, presença de doença pelo citomegalovírus e rejeição ou doença do enxerto contra o hospedeiro. O fator de risco associado à evolução para o óbito foi a presença de AI. Foram observados bons desempenhos para a GM tanto no soro como no LBA com LR menores que os registrados na literatura. O melhor desempenho da GM no soro para aspergilose+provável ocorreu com LR de 0,35 com sensibilidade-S, especificidade-E, valor preditivo positivo- VPP), valor preditivo negativo-VPN) e área sob a curva-ASC de 54,4%, 73,4%, 50,8%, 76,2% e 0,64, sendo os valores superiores para aspergilose provada tanto na S, como E, VPN. No LBA os valores de S-E-VPP-VPN-ASC para GM para LR de 0,65 para aspergilose provável + provada foram 58,3%, 92,6%, 87,5%,71,4% e 0,75, sendo na aspergilose provada os valores de S, e VPN superiores. Nesta casuística, o melhor desempenho para BDG no soro apontou para uma LR de 100 pg/mL na aspergilose provável+provada, com 54,5%, 73,4%, 50,8% e 76,2%, 0,64 respectivamente para S-E-VPP-VPN-ASC. Para BDG no LBA, a LR na aspergilose provável + provada foi de 140 pg/mL, com os mesmos valores de 46,7%, 76,7%, 70%, 55,6% e 0.62, respectivamente. Conclusão: A GM no LBA e no soro foram úteis no diagnóstico da aspergilose mediante emprego de LR menores, sendo mais sensível na LBA, principalmente em estágios iniciais da forma angioinvasiva. A persistência de GM sérica foi relacionada ao óbito em relação à negativação da mesma. A proporção de concordância entre a TC e os biomarcadores no soro e no LBA variou de 0,5 a 0,6, com pequena concordância na estatística kappa. Excelente concordância foi observada entre dois radiologistas independentes, que analisaram de maneira cega as TC de sujeitos com aspergilose provada. Nesta casuística com inclusão de doenças sistêmicas e endêmicas, a BDG teve baixo desempenho diagnósticoInvasive aspergillosis (IA) has become the leading infectious cause of death in immunocompromised hosts, particularly in subjects under SCTH and hematologic neoplasias. Objectives: General: To compare the performance of GM and BG tests in serum and bronchoalveolar lavage fluid (BAL) and computer tomography (CT) scans in the diagnosis of IA in immunocompromised hosts as well as their role in the patient outcome. Specific: 1. To analyse the sensitivity and specificity of Galactomannan and 1,3 betaD-glucan assays in the serum and bronchoalveolar lavage. 2. To compare the results of Galactomannan and 1,3betaD-glucan assays with CT scans in patients with invasive aspergilosis. 3. To analyse the relationship between the evolution of galactomannan levels and clinical outcome (death or survival). Patients, Materials and Methods: From December 2008 to March 2013, a prospective cohort of 398 patients from several wards of immunocompromised patients of Hospital das Clínicas, Faculdade de Medicina, University of São Paulo was included classified in two groups of patients: 202 (51%) with invasive aspergillosis (IA) and 198 (49%) control patients. Results: Considering 202 cases, 18(8.8%) were subjects with proven, 28(13.7%) with probable aspergillosis and 156(77.5%), with possible aspergillosis, according to 2002 EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria. The most common underlying disease were: HSCT (42.7%), hematologic malignancy (37%), SOT (9%), or other diseases (11.3%). The main risk factors associated with IA were neutropenia, monocytopenia, patients under corticosterois, presence of CMV disease, and rejection or graft versus host disease. The risk factor associated with death was the presence of invasive aspergillosis. Good performances for serum and BAL GM were registered with lower cutoffs in the present workin relationship to those found in the literature. The best cutoff for proven + probable aspergillosis for serum GM was observed at 0.35 vallue with Sensitivity-S, Specificity-Sp, Positive Predictive value-PPV), Negative Predictive Value-NPV) and AUC of 54.4%, 73.4%, 50.8%, 76.2% and 0.64; the values for proven aspergillosis alone were higher for S, Sp and NPV. On BAL tests for GM (cutoff value of 0.65) in proven+probable aspergillosis we observed 58.3%, 92.6%, 87.5%,71.4%, 0.75, respectively as S-Sp-PPV-NPVAUC; the sensitivity and VPN were higher in proven aspergillosis alone. In this work, the best performance in proven+probable aspergillosis for serum BDG showed 100 pg/ML as cutoff value, with 54.5%, 73.4%, 50.8%,76.2%, 0.64 for S-Sp-PPVNPV- AUC, respectively. For BAL- BDG, the cut off for proven+probable aspergillosis was 140 pg/mL, and we observed 46.7%, 76.7%, 70.0%, 55.,6%, 0.62, respectively for for S-Sp-PPV-NPV-AUC. Conclusion: The serum and BAL GM are useful tests for diagnosis in early stages of angioinvasive form at lower cutoffs; BAL GM is more sensitive. Agreement proportion between CT scan and each biomarker in the serum or BAL ranged from 0.5-0.6, with low ? index. Perfect ? statistic was observed for analysis of CT scan of subjects in proven aspergillosis by two independent radiologists, blinded for diagnosis. Persistence of serum GM was associated to death in relationship with its negativation. BDG test showed low performance in this work, where systemic and endemic diseases were included
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Delebarre, Mathilde. "Prédire l’infection sévère lors des épisodes de neutropénie fébrile post-chimiothérapie de l’enfant : développement d’une règle de décision clinique." Thesis, Lille 2, 2016. http://www.theses.fr/2016LIL2S018/document.
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Contexte: Le pronostic des neutropénie fébrile (NF) post-chimiothérapie de l’enfant a été amélioré par une antibiothérapie à large spectre systématique. Cependant des infections sévères ne surviennent que dans 15-25% des cas. Il a été recommandé en 2012 de faire évoluer la prise en charge en tenant compte du risque infectieux en utilisant des règles de décision clinique (RDC). Nous avions montré que les outils publiés pour distinguer ce risque étaient peu performants, non validés ou non applicables sur notre population. Une nouvelle RDC (score) permettant de distinguer les épisodes de NF à bas risque d’infection sévère a été construite. Cette RDC a été validée en interne. Compte tenu des différences mises en évidence dans les populations de tumeurs solides et d’hémopathies, il pourrait être pertinent d’utiliser un arbre de décision clinique pour classer le risque infectieux dont la première division serait le type de cancer et de valider cette nouvelle RDC.L’objectif de ce travail était de calibrer cette RDC sous forme d’arbre et de la valider sur un échantillon multicentrique pour distinguer les enfants avec NF à bas risque d’infection sévère. Méthodes: La première étape a été d’évaluer la méthodologie de développement des RDC déjà publiées pour identifier d’éventuelles limites méthodologiques. Ensuite, nous avons décrit les différences entre les hémopathies ou avec les tumeurs solides. Puis, la nouvelle RDC a été calibrée sous forme d’un arbre de décision à l’aide du logiciel Sipina. Sa performance a été évaluée en termes de sensibilité (Se), spécificité (Sp), et rapport de vraisemblance négatif (RVN).En parallèle, un protocole de validation multicentrique prospectif a été monté, avec pour objectif une Se proche de 100% et un RVN inférieur à 0,1. Il a été validé par le CCTIRS et par la CNIL. Il a été financé par la Ligue Contre le Cancer (72 000 euros). Trente et un centres ont été recrutés. La RDC n’a été appliquée qu’a posteriori ; la prise en charge de cette population n’a donc pas été modifiée. La performance de la RDC entre la population de validation et construction a été analysée en termes de Se, Sp, RVN. L’évaluation des pratiques de prise en charge des NF post-chimiothérapie de l’enfant a été faite en parallèle sous la forme d’une enquête nationale, dans la perspective d’une étude d’impact ultérieure.Résultats: L’étude de la méthodologie des RDC déjà publiées a montré que les critères de développement d’une RDC étaient respectés dans 71% des cas (médiane). Une RDC avait atteint le plus haut niveau d’évidence, mais sa population de construction était différente de la nôtre et cette RDC n’était pas reproductible sur notre population. Il existait 2 à 3 fois plus d’infection sévère chez les patients atteints d’une hémopathie maligne. Deux arbres de décision ont donc été construits pour différencier le risque d’infection sévère. Pour les patients avec une tumeur solide il avait des Se de 96%, Sp de 59% et RVN à 0,07, pour ceux avec une hémopathie maligne, il avait des Se de 99%, Sp de 52% et RVN à 0,03. Les inclusions de la validation multicentrique se sont déroulées de janvier 2012 à mai 2016. 1806 épisodes ont été inclus (333 infections sévères, 18,4%). L’application de la RDC a été faite a posteriori(en cours). L’enquête nationale menée en parallèle sur la prise en charge faite en pratique dans les centres français a montré une grande variabilité de prise en charge notamment dans les définitions de la neutropénie et de la fièvre. Un travail doit être initié avec la Société Française des Cancers de l’Enfant pour uniformiser la prise en charge des NF et déterminer le type d’allègement thérapeutique à proposer en vue de l’étude d’impact, en utilisant cette RDC. Conclusion: Les étapes de construction et de validation de cette nouvelle RDC ont été réalisées en respectant les standards méthodologiques. Une étude d’évaluation de l’impact de la RDC devra être mise en place pour atteindre le plus haut niveau d’évidencePurpose: Chemotherapy-induced febrile neutropenia (FN) is known to be a risk for severe infection and death in the absence of prompt and appropriate antibiotic therapy. Immediate hospitalization for rapid institution of empirical broad-spectrum intravenous antibiotic therapy has led to reduce the mortality. However, documented or severe infections occur in only 15-25% of cases. In 2012 paediatric guidelines suggested to adapt the management of FN episodes to the infectious risk. In a previous work, none of the published clinical decision rules (CDRs) to rule out severe infections have been validated and have only rarely been tested in an external set of children. The methodological standards used to derive and validate these CDRs were a real concern. A new CDR was previously derived as a scoring system in Lille to classify the patients at high or low risk of severe infection, with a dataset collected in 2 centers in Lille, in following methodological standards. Differences between solid tumours and blood cancers were observed in children with FN for numbers and types of infections. As a result, we considered relevant to build a decision tree model to predict the low risk for severe infection with a first division that could be the type of cancer. This new decision rule was already validated in an internal set of data, but required an external validation.The aim of this project was to calibrate the CDR as a decision tree and validate its performance a posteriori in an external set of patients, using prospectively collected data from multiple centers.Methods: the methodological standards of available CDRs were first analysed. The new CDR derived on a bicentric dataset was reused to calibrate the CDR as a decision tree, using Sipina software. A prospective multicentric observational protocol funded by 72000€ provided by “la Ligue Contre le Cancer” was developed for an external validation of the CDR to expect near 100% sensitivity (Se) and a negative likelihood ratio (LR) below 0.1. The ethical regulation was followed. Thirty-one centers were recruited in France (27/30 referent centers for management of children with cancer, and 4 proximity centers fit to manage children with FN). The CDR was not applied to the included patients, and remained confidential. The data were collected on an e-CRF “capture system”. The data were captured by an assistant of clinical research and controlled by a physician researcher after the monitoring of the data in all centers. The CDR was a posteriori applied on the dataset. The performance of the CDR between validation and derivation sets of patients was analysed in terms of Se, specificity (Sp) and negative LR.Results: the methodological standards of development of a CDR were not always followed for the development of the published CDR predicting infection for FN in children. Only one CDR followed all criteria and reached the highest level of evidence, but this CDR was built in a very different population from our and was not reproducible. A decision tree model of the CDR was built to distinguish children with FN at low risk of severe infection. For children with solid tumours, the CDR had 96% Se, 59% Sp, and a negative LR at 0.07. For children with blood cancers, the CDR had 99% Se, 52% Sp, and a negative LR at 0.03.For external validation, inclusions started in 2012 until May 2016. Of the 31 centers, 23 included 1806 cases (333 severe infections [18.4%]). The retrospective application of the CDR on all included case in ongoing. A national survey was also conducted as the same time to analyse the real management of children with FN in France in order to determine the type of management that could be proposed for low risk patients when the CDR will be tested in an impact study.Conclusion: the different steps for the construction and validation of the new CDR were conducted following standards. This CDR is in progress to reach the highest level of evidence
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Venâncio, Isaura Marina Soares. "Neutropenia febril em doentes oncológicos." Dissertação, 2013. https://repositorio-aberto.up.pt/handle/10216/72391.
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Venâncio, Isaura Marina Soares. "Neutropenia febril em doentes oncológicos." Master's thesis, 2013. https://repositorio-aberto.up.pt/handle/10216/72391.
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Costa, Ricardo José Craveiro da. "O Desafio Clínico Iminente da Neutropenia Febril: Uma Análise Retrospetiva." Master's thesis, 2018. http://hdl.handle.net/10316/82661.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: A Neutropenia Febril é definida como uma contagem absoluta de neutrófilos inferior a 500 células/mm3, ou prevendo-se que alcance esse valor em 48 horas, acompanhada de uma medição da temperatura corporal superior a 38,3.ºC ou duas medições consecutivas acima de 38.ºC no período de 2 horas. É uma complicação frequente da quimioterapia utilizada no tratamento da doença oncológica que, pelos seus efeitos mielossupressores, predispõe o doente à infeção por múltiplos microrganismos, constituindo um desafio clínico transversal a várias especialidades médicas e cirúrgicas.Objetivo: Procura-se proceder a uma atualização de conhecimentos no diagnóstico e tratamento da Neutropenia Febril, complementando-a com uma análise retrospetiva de uma população selecionada de doentes com Leucemia, internados no Serviço de Hematologia do CHUC.Material e Métodos: Foram estudados 39 doentes com diagnóstico estabelecido de Leucemia, internados no Serviço de Hematologia do CHUC para realização de quimioterapia. Optou-se por realizar a colheita dos dados referentes apenas ao primeiro internamento complicado por Neutropenia Febril, que cada doente teve, no período de novembro de 2015 a janeiro de 2017. A informação colhida incluiu dados demográficos, o tipo de patologia oncológica de base, o regime de quimioterapia realizado, o número de dias de internamento, o número de dias de neutropenia grave, de febre e de neutropenia febril propriamente dita, o(s) microrganismo(s) envolvido(s), o(s) fármaco(s) antimicrobiano(s) prescrito(s), o número de dias em que se realizou antibioterapia, o recurso a fatores de crescimento hematopoiéticos e a ocorrência ou não de óbito de causa infeciosa, para cada doente. Os dados coletados foram tratados e interpretados com recurso ao software IBM SPSS Statistics versão 24. Resultados: A maioria dos doentes em estudo era do sexo masculino (61,5%) e a média de idades da amostra era de 56,4 ± 14,4 anos, tendo as mulheres uma média de 52,3 ± 16,3 anos e os homens uma média de 59,0 ± 12,8 anos. Dos 39 doentes, dois tinham o diagnóstico de Leucemia Plasmocítica, dois apresentavam LLA, um tinha Leucemia Aguda de Linhagem Ambígua e outro tinha o diagnóstico de Neoplasma de Células Dendríticas Plasmocitóides Blásticas. A maioria (84,5%) tinha Leucemia Aguda Mielóide, tendo sido os dois subtipos mais observados a LMA com alterações relacionadas com Mielodisplasia, em 26% dos doentes em estudo e a LMA com mutação NPM, em 18% dos mesmos. Em média, os internamentos tiveram a duração de 35,2 ± 13,0 dias e foram realizados com vista à implementação de quimioterapia para a doença de base, tendo a maioria dos doentes sido submetida a QT de Indução, em que o protocolo mais utilizado foi o 3+7 com Idarrubicina e Citarabina, administrado em 26% dos casos. Os doentes apresentaram uma média de 20,8 ± 10,2 dias de neutropenia, 11,0 ± 7,6 dias de febre e 7,7 ± 4,8 dias de NF. Em 33,3% dos casos não foi identificado nenhum microrganismo em cultura, contudo em 30,7% conseguiram-se isolar vários microrganismos, em culturas diferentes e no mesmo doente, durante o período total de internamento. Nos casos em que se identificou um único microrganismo durante o internamento (36%), os mais frequentemente observados foram as bactérias Gram-negativas E. Coli, e Klebsiella pneumoniae, seguidas pelas bactérias Gram-positivas S. aureus e MRSA. A média de dias de uso de antibioterapia foi de 19,8 ± 9,4 dias e o antibiótico prescrito o maior número de vezes foi a Piperacilina/Tazobactam. O uso de fatores de crescimento, conjuntamente com fármacos antimicrobianos, foi realizado nos doentes com LLA, com Leucemia Plasmocítica e em três doentes com LMA. O óbito ocorreu em 10,3% dos doentes, sendo que em 7,7% a sua etiologia foi infeciosa, nomeadamente choque séptico e abcesso cerebral.Conclusão: (...) Embora se considere necessário aumentar a amostra para que se possam tirar conclusões mais assertivas considera-se que, ainda que tenham ocorrido inúmeros avanços nas últimas décadas relativamente à patologia oncológica e seu respetivo tratamento, a supressão da atividade medular e consequentes complicações derivadas do mesmo, com uma maior propensão à infeção, continuam a apresentar-se como adversidades que colocam em risco a vida do doente com cancro pelo que continua a ser essencial e pertinente a continuação do seu estudo. Porém, pela positiva, mesmo tendo em conta que o tratamento de determinados tipos de Leucemia, como a LMA, não se altera desde há mais de 20 anos, todos os avanços realizados nos tratamentos dirigidos às doenças hematológicas contribuíram para um aumento da sobrevida dos doentes. Tal deve-se ao melhor suporte das complicações, com uma abordagem mais adequada da infeção, melhor uso dos antibióticos disponíveis e desenvolvimento de novos antifúngicos. (...)
Background: Febrile Neutropenia is usually defined as an absolute neutrophyle count below 500 cells/mm3 or predicted to reach that value in a 48-hours period, accompanied by a single measure of body temperature higher than 38.3.ºC or two consecutive measures above 38.ºC in a 2-hours period. It is a frequent complication of chemotherapy drug regimens used on oncological diseases that, because of their myelosuppressive side effects, make the patient susceptible to infection from multiple microrganisms, which composes a clinical challenge present in several medical and surgical specialities.Objective: The main goal is to proceed with an update on the knowledge about the diagnosis and treatment of Febrile Neutropenia, complementing it with a retrospective analysis of a selected population of Leukemia patients admitted to the Heamatology Service of Centro Hospitalar da Universidade de Coimbra.Methods: 39 patients with an established diagnosis of Leukemia, admitted to the Hematology Service of CHUC, in order to be submitted to chemotherapy, were selected to take part in this study. It was chosen to collect data concerning only the first admission complicated by Febrile Neutropenia, that each patient had, between november 2015 and january 2017. The gathered information included demographics, the type of primary oncological disease, which chemotherapy regimen was used, number of days spent in the hospital, number of days with severe neutropenia, with fever and with actual febrile neutropenia, which microorganism(s) was(were) involved, which antimicrobial drugs were used, number of days each patient received antibiotics, the use of hematopoietic growth factors and the occurrence, or not, of death caused by infection. The collected data was organised and interpreted with the help of the software IBM SPSS Statistics version 24.Results: Most patients that took part on this study were male (61,5%) and the mean age of the population was 56,4 ± 14,4 years old, with women having a mean age of 52,3 ± 16,3 years old and men a mean age of 59,0 ± 12,8 years old. Of the 39 patients studied, two had the diagnosis of Plasmocytic Leukemia, two presented with ALL, one had been diagnosed with Acute Leukemia of ambiguous lineage and one had Blastic plasmocytoid dendritic cell neoplasm. Most of the individuals (84,5%) had been previously diagnosed with Acute Leukemia of myeloid lineage, with the two subtypes most frequently observed being AML with Myelodysplasia related-changes in 26% of the analysed patients and AML with mutated NPM1 in 18% of them. The median length of the admissions was 35,2 ± 13,0 days and patients were admitted mainly to initiate chemotherapy for the underline neoplasic disease. Most patients underwent an induction chemotherapeutic regimen, of these being the most frequently used the regimen 3+7 with Idarrubicin and Cytarabine, administered in 26% of cases. In this study, patients presented a mean of 20,8 ± 10,2 days of neutropenia, 11,0 ± 7,6 days of fever and 7,7 ± 4,8 days of febrile neutropenia. In 33,3% of cases, no microorganism was identified in cultures, however, in 30,7% of cases it was possible to isolate multiple microorganisms, in different cultures on the same patient, during the total lenght of admission. In the cases where only one microorganism was identified during the admission (36%), the most frequently observed were the Gram-negative bacteria E. Coli. and Klebsiella pneumoniae, followed by the Gram-positive S. aureus and MRSA. The mean number of days of antibiotic therapy was 19,8 ± 9,4 days and the antibiotic most often prescribed was Piperacillin/Tazobactam. The use of growth factors, together with antimicrobial drugs, was performed in the patients with ALL, those with Plasmocytic Leukemia and in three patientes with AML. Death ocorred in 10,3% of the patients, with 7,7% of deaths having na infectious etiology, mainly septic shock and cerebral abcess.Conclusions: (...) Although it is considered necessary to increase the size of the sample in order to achieve more assertive conclusions, we understand that despite the innumerous scientific and medical advances observed in the last few decades concerning oncological pathology and its treatment, the supression of the medullary activity and following complications, with a higher susceptibility to infection, remains a adversity that puts at risk the life of the cancer patient, which is why it still is essential and necessary to continue the study of this subject. Meanwhile, on the brighter side, although the treatment for several kinds of Leukemia, like AML, remains the same for the last 20 years, each improvement accomplished concerning the treatment of hematological diseases, contributed to a higher life expectancy for the patients. That is due, mainly, to the a better support of complications, with a better approach to infection, a better use of the available antibiotics and the development of new antifungal drugs. (...)
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Teuffel, Marc Oliver. "Comparison of Different Strategies for the Management of Febrile Neutropenia in Children - A Cost-utility Analysis." Thesis, 2010. http://hdl.handle.net/1807/30130.
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Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting.
Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER).
Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy.
Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.
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Lathia, Nina. "Economic Evaluation of Strategies to Prevent and Treat Febrile Neutropenia in Lymphoma Patients." Thesis, 2013. http://hdl.handle.net/1807/65512.
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This thesis employed methods used in health care decision making to evaluate strategies for prevention and treatment of febrile neutropenia (FN) in non-Hodgkin lymphoma (NHL) patients. The objectives of this thesis were to quantify the cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against FN in NHL patients, to develop an algorithm for converting health-related quality of life data collected in non-Hodgkin lymphoma patients into preference-based health utility values, and to evaluate NHL patients’ preferences for outpatient treatment of FN. The cost-effectiveness analysis demonstrated that neither filgrastim, nor pegfilgrastim are cost-effective, with respective incremental cost-effectiveness ratios [95% confidence interval] of $4,599,000/QALY [$597,045, dominated] and $6,272,000/QALY [$730,692, dominated], well above the normally accepted threshold of $50,000/QALY. The algorithm for deriving health utility values was based on a regression model that used health utility values obtained from the EQ-5D instrument as the outcome variable and the four subscales of the Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire as the predictor variables. The model final model included three of the FACT-G subscales, and had an R-squared value of 0.502 and a mean squared error of 0.013. A discrete choice experiment was used to examine patients’ preferences for out patient treatment of FN, and demonstrated that out-of-pocket costs, unpaid caregiver time required daily, and probability of return to hospital are all significant attributes when considering outpatient therapy for FN. Adjusted odds ratios [95% confidence intervals] of accepting outpatient treatment for FN were 0.84 [0.75 to 0.95] for each $10 increase in out-of-pocket cost; 0.82 [0.68 to 0.99] for each 1 hour increase in daily unpaid caregiver time; and 0.53 [0.50 to 0.57] for each 5% increase in probability of return to hospital. These results provide important information for clinicians and health care decision makers involved in implementing programs for NHL patients with FN.
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Hartmann, Claudia. "Meropenem versus Ceftazidim als initiale Monotherapie bei febriler Neutropenie immunsupprimierter Kinder und Jugendlicher /." 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=012848236&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Liu, Cheng-Chung, and 劉承忠. "Study on the Use of G-CSF in Breast Cancer Patients for Managing Chemotherapy-induced Febrile Neutropenia." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/58531561954385730376.
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碩士臺北醫學大學
藥學研究所
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Rationale Febrile neutropenia (FN) is a serious hematological toxicity of cancer chemotherapy and could be prevented with the prophylactic use of antibiotics and/or granulocyte colony-stimulating factor (G-CSF). G-CSF is hematopoietic growth-stimulating factor, which regulates the proliferation, differentiation and function of hematopoietic cells. G-CSF dose-dependently increases the cell number of circulating neutrophils. Early clinical trials indicated that primary prophylaxis with G-CSF reduces the duration of chemotherapy-induced neutropenia resulting in a 50% reduction in FN, infections, hospitalization, and the use of antibiotics in small cell lung cancer patients. In the study, the rate of FN was reduced from 77% to 40%, with long-term G-CSF treatment started on day 4 and continuing through day 17. Regarding to breast cancer patients, G-CSF as primary prophylaxis administered on days 4 to10 after TAC (adriamycin, paclitaxel, and cyclophosphamide) chemotherapy regimen lead to a reduction of FN risk from 27.5% to 7.5%. Based on the practice guidelines, primary prophylaxis of G-CSF treatment protocol can only be used for high risk patients with FN. Objective G-CSF is relatively expensive medicine. Currently, at the Sun Yat-Sen Cancer Center (SYSCC), G-CSF was prescribed to patients with prior severe neutropenia or FN for only three days due to the regulation of national health insurance (NHI). The main objective of this study was to investigate the rate of FN after primary and secondary prophylaxis of G-CSF in breast cancer patients (n=511); the secondary objectives were to investigate the prescribing pattern of G-CSF at SYSCC and to evaluate the cost-effectiveness of G-CSF use under the regulation of NHI. Study Design We performed a retrospective chart review of breast cancer patients who received chemotherapy or lenograstim at SYSCC during year 2007. The information included in this review were patients’ age, sex, tumor type, dosage of chemotherapy, the dose and duration of G-CSF, history of FN and neutropenia, and the length and cost of hospitalization due to FN. Then, we divided patients into three groups according to the risk of FN on received chemotherapy regimen, high (>20%), intermediate (10-20%), low (<10%), to find out the FN risk in different groups and also the regimen of lenograstim use. Furthermore, we focus on the FN risk and regimen of G-CSF use in patients with breast cancer who received chemotherapy regimen of TAC, ATC, and CAF. All these data will be analyzed and compared with the current literature to evaluate the efficacy and cost-effectiveness of G-CSF. Finally, a decision-analysis model was constructed from a health insurer’s perspective to evaluate the cost-effectiveness by considering direct medical costs only. The data required for the decision-analysis model were obtained from the medical literature and data from SYSCC. Results Between January 2007 and December 2007, 511 breast patients who received both chemotherapy and lenograstim at SYSCC were enrolled in the study. Patients in the high risk group (TAC) did not have significantly reduced rate of FN (33.33%) after receiving lenograstim treatment for 3 days. Furthermore, the three common chemotherapy regimens for the treatment of breast cancer were (i) sequential treatment with doxorubicin, paclitaxel, and cyclophosphamide (ATC), (ii) combined treatment with doxorubicin, docetaxel, and cyclophosphamide (TAC), and (iii) treatment with cyclophosphamide, doxorubicin, and 5-fluorouracil (CAF). Comparison of three treatment groups, group TAC (33.33%, with primary prophylaxis G-CSF) was associated with higher FN incidence than ATC (6.66%, with primary prophylaxis G-CSF) and CAF (5.97%, with secondary prophylaxis G-CSF) groups after 3 days lenograstim treatment. And the duration of lenograstim were 3.19 days in CAF group, 6.08 days in ATC group, and 2.95 days in TAC group, respectively. Finally, most of patients in the TAC and CAF groups received only 3 days of G-CSF prophylaxis due to the regulation of national health insurance (NHI). After the cost-effectiveness analysis, the incremental cost-effectiveness ratio (ICER) in comparison of 7-day treatment regimen (according to clinical trials) versus 3-day treatment regimen was unacceptably high (N.T.120,265 per FN episode avoided). Discussion The higher FN incidence in breast cancer patients of high risk chemotherapy regimen after G-CSF prophylaxis may be due to the short duration of G-CSF use. The risks of FN in TAC group of SYSCC and the prior study were 33.33% and 7.5%, respectively. This 5-fold higher risk in the TAC group may be due to the difference in period of G-CSF prophylaxis reducing from 7 days to 3 days in the SYSCC. In ATC group, the risk of FN in the present study (6.66%) was 3 times higher than the report of Citron et al. (2%). Earlier studies indicate the risk of developing FN in patients received CAF chemotherapy are ranging from 2 to 5 % while in the present study the risk was similar (5.97%). The reason of unexpected higher incidence of FN in TAC regimen is unclear, but is highly likely that the decreased efficacy was due to short time period (3 days) of G-CSF treatment. Concluding Remark Based on present results, patients who received chemotherapy of high risk in FN and G-CSF for primary prophylaxis still had the rate of FN 33.33%. The result may be due to the 3-day G-CSF use under the regulation of NHI. Moreover, many patients under 3-day G-CSF regimen may further require another 3-day G-CSF regimen to support the developed neutropenia. Additionally, the cost-effectiveness model provides evidence that 7-day G-CSF regimen is not only cost-effective but also cost-saving in clinical settings. There appeared to be both clinical and economic benefits from prophylaxis with standard administration (7-day) of G-CSF. Therefore, further prospective study should be performed to find out the most appropriate duration of G-SCF use. The result could be provided as an evidence to persuade and modify the reimbursement policy of NHI.
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Hamdouchi, Majid [Verfasser]. "Analyse geschlechtsspezifischer Unterschiede bei febriler Neutropenie von Patienten mit akuter myeloischer Leukämie / vorgelegt von Majid Hamdouchi." 2009. http://d-nb.info/1000896870/34.
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Lathia, Nina. "Evaluation of direct medical costs, lost productivity, health utility and quality of life in patients hospitalized for febrile neutropenia." 2008. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=772050&T=F.
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