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Dissertations / Theses on the topic 'Neutropeni'

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Published: 4 June 2021
Last updated: 9 February 2022

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1

Lilja, Carina, and Karin Svensson. "Omvårdnadsåtgärder vid neutropeni orsakat av cytostatika." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24253.

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Lilja, C & Svensson, K. Omvårdnad vid neutropeni orsakat av cytostatika. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2008.Neutropeni är en allvarlig komplikation hos patienter som behandlas med cytostatika och är förenat med risk för vårdrelaterade infektioner och sepsis som kan vara livshotande. Ibland behövs skyddsisolering på sjukhus med risk för vårdrelaterade infektioner. Syftet var att ur ett sjuksköterskeperspektiv belysa omvårdnaden under skyddsisoleringen samt vilka infektionsförebyggande åtgärder som är av betydelse. Metoden var en litteraturstudie som bygger på 17 vetenskapliga artiklar. Resultatet visar olika omvårdnadsaspekter som är betydelsefulla vid neutropeni. Olika infektionsförebyggande åtgärder för att hindra endogen och exogen smitta belystes. Smittspridningen förhindras genom användning av basala hygienrutiner och handdesinfektion. Patienter med neutropeni som skyddsisoleras på sjukhus är en utsatt och svårt sjuk patientgrupp vilket gör det svårt att randomisera tillräckligt stora, väldesignade och jämförbara studier. Det saknas forskning inom omvårdnaden. Säkra rekommendationer med hög trovärdighet kan inte ges med denna bakgrund. Behov finns att kritiskt utvärdera de insatser som görs idag och att utveckla forskningen av omvårdnaden av patienter med cytostatikaorsakad neutropeni.
Lilja, C & Svensson, K. Chemically induced neutropenia: The need of nursing care. A literature review. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2008.Neutropenia is a serious complication among cancer patients who receive chemotherapy and can cause life threatening cross infections and sepsis. Protective care at hospital is sometimes needed with risk for cross infections. The purpose of this review was to highlight the nursing care of patients in protective care and to indicate the most important actions to prevent cross infections. A literature review was used as method based on seventeen scientific articles. The result showed actions of nursing care that are important during protective care at hospitals. The result also showed interventions to prevent cross infections caused of endogenous and exogenous source. There are few well designed studies and there is a lack of comparable empirical evidence. These patients are very ill and vulnerable and it is difficult to perform randomized studies with enough sample size to get well designed and comparable studies. Therefore recommendations can not be given that are based on high level of evidence. There is a need to develop evidence based nursing methods and to identify and evaluate nursing interventions so that the best possible care of patients with chemically induced neutropenia in protective care is given.
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2

Sjögren, Erik, and Nellie Haraldsson. "Isoleringsrutiner gällande livsmedelsbegränsningar för patienter på sjukhus där allogena stamcellstransplantationer genomförs." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-314355.

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Bakgrund: Stamcellstransplantation är en behandlingsmetod mot flera olika typer av leukemi. Efter transplantationen blir patienten infektionskänslig. Vid detta tillstånd skyddsisoleras patienten och får en livsmedelsbegränsad kost.Syfte: Sammanställa och jämföra isoleringsrutiner gällande livsmedelsbegränsningar för patienter vid Sveriges hematoloigavdelningar där allogen transplantation sker och jämföra med aktuell forskning bakom livsmedelsbegränsningar.Metod: Tvärsnittsstudie vid jämförelsen av livsmedelsbegränsningarna vid Sveriges hematologiavdelningar samt en litteraturstudie vid undersökningen av aktuell forskning i databaserna Pubmed och Cinahl.Resultat: I tvärsnittsstudien använde alla sjukhusen olika rutiner. Ingen signifikant skillnad gällande infektionsincidensen mellan patienter som hade livsmedelsbegränsningar jämfört med de som inte hade det fanns i litteratursökningen.Slutsats: Livsmedelsbegränsningar minskar troligtvis inte infektionsrisken för infektionskänsliga patienter. Det behövs högkvalitativ forskning för att utforma tydliga riktlinjer kring vilka livsmedelsbegränsningar som bör användas.
Background: Stem cell transplantation is a treatment for patients with leukemia. After the transplantation, the patients are at a higher risk of getting an infection and are therefore kept in protective isolation and get a food restricted diet.Purpose: To compile and compare the differences in food restricted diet for neutropenic patients at the hematology departments in Sweden where stem cell transplantation is performed and compare food restricted diet to current research.Method: A cross-sectional study to compare the food restrictions and a literature study to find out what the current research says using Pubmed and Cinahl.Result: The cross-sectional study showed that all the hospitals used different diets. In the literature review, no significant difference regarding infections rates when comparing patients who ate a food restricted diet with those who did not.Conclusion: Food restrictions are unlikely to reduce the infection rate of neutropenic patients. More high quality research is needed to formulate clear guidelines about what food restricted diet should be used.
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3

Dufoir, Thierry. "Etude comparative de différentes modalités d'administration de la Vancomycine chez le patient neutropénique." Bordeaux 2, 1993. http://www.theses.fr/1993BOR2P042.

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4

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.

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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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5

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.

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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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6

Rizzo-Padoin, Nathalie. "Modifications pharmacocinétiques des antibiotiques chez le patient neutropénique : application à la téicoplanine." Paris 5, 1995. http://www.theses.fr/1995PA05P175.

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7

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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8

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’évidence
Purpose: 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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9

Girod, Caroline. "Le Neupogen* : utilisation et étude à l'hopital Saint-André de Bordeaux." Bordeaux 2, 1994. http://www.theses.fr/1994BOR2P034.

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10

Bellesso, Marcelo. "Tratamento ambulatorial da neutropenia febril." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5167/tde-02062009-093637/.

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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.

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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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Gonzalez, Luiz Ricardo 1963. "Neutropenia étnica benigna em trabalhadores hígidos." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311991.

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Orientador: Satoshi Kitamura
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-20T19:15:33Z (GMT). No. of bitstreams: 1 Gonzalez_LuizRicardo_D.pdf: 1852973 bytes, checksum: fe261b80338f57f34b13efff35148a9f (MD5) Previous issue date: 2012
Resumo: Justificativa e Objetivos: Neutropenia étnica benigna é uma condição caracterizada por uma redução da contagem dos neutrófilos abaixo de 1.500/mm³ na circulação sanguínea, estando ausentes as causas secundárias, adquiridas ou congênitas.Ocorre, principalmente, em populações negras e seus descendentes, não apresentando problemas recorrentes de infecção. Diversos trabalhos realizados, ao redor do tema em outros Países, em que a etnia negra é importante na composição populacional, como no Brasil, mostra à importância do conhecimento da neutropenia étnica.A proposta do presente estudo foi investigar a prevalência de neutropenia étnica benigna,no meio de uma população trabalhadora, aparentemente saudável, sendo realizado em um Hospital de grande porte na cidade de São Paulo-Brasil. Método: Trata-se de um estudo transversal, envolvendo 347 voluntários, que estavam dentro dos critérios de inclusão do estudo. Resultados: Os dados deste trabalho demonstram que entre os trabalhadores estudados, 9 (2,59%) apresentaram critérios diagnósticos para neutropenia étnica benigna. Relativamente em relação aos brancos participantes, os negros, pardos e amarelos apresentaram menor contagem de neutrófilos.Conclusão: Levando-se em consideração o aspecto racial, este estudo mostra que pessoas negras e seus descendentes podem apresentar uma diminuição na contagem de neutrófilos, sem predisposição a infecções
Abstract: Background and Objectives: Benign ethnic neutropenia is a condition characterized by a neutrophil count reduction under 1.500/mm³ in blood circulation, with absence of acquired or congenital secondary causes. It occurs mainly among afro populations or their descendants not presenting problems with recurrent infections. Different papers performed in other countries, in which the Black ethnicity is important in the population composition, such as in Brazil, discuss the importance of knowing about ethnic neutropenia. The aim of this study was to investigate the prevalence of benign ethnic neutropenia in an apparently healthy working population of a large hospital in the city of Sao Paulo, Brazil. Method: This transversal study comprised 347 volunteers who met the inclusion criteria. Results: According to this study, nine (2.59%) among the studied employees met the diagnostic criteria for benign ethnic neutropenia. Compared to Caucasian participants, Black, Brown and Yellow people presented a lower neutrophil count. Conclusion: Considering the racial aspect, this study showed that afro people and their descendants may present a neutrophil count reduction, without predisposition to infections
Doutorado
Epidemiologia
Doutor em Saude Coletiva
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13

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.

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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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Haurie, Caroline. "Cyclical neutropenia : data analysis and modeling study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ50784.pdf.

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Person, Richard Erwin. "Mislocalization of neutrophil elastase is the major cause of inherited neutropenia /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/6314.

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BELAID, KARIM. "Neutropenie chronique benigne de l'enfant : revue de la litterature a propos d'un cas." Reims, 1990. http://www.theses.fr/1990REIMM123.

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Cariou, Vincent. "Profil pharmacologique et toxicologique d'un facteur de croissance cellulaire granulocytaire : le filgrastime." Paris 5, 1996. http://www.theses.fr/1996PA05P024.

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Pariente, Laura. "Evaluation du Céfépime en perfusion continue dans le traitement empirique des neutropénies fébriles chimioinduites." Bordeaux 2, 1999. http://www.theses.fr/1999BOR2M137.

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Fruchet, Estelle. "L'utilisation du G-CSF dans les neutropénies chimio-induites des cancers broncho-pulmonaires." Paris 5, 1995. http://www.theses.fr/1995PA05P269.

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Violante, Ana Cristina Martins da. "Contribuição para o estudo da utilização de fatores estimuladores de colónias de granulócitos no maneio de doenças associadas a neutropénia em cães e gatos : estudo retrospetivo de 30 casos clínicos (2011 – 2016)." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/12721.

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Dissertação de Mestrado Integrado em Medicina Veterinária
A neutropénia é um achado hematológico que se encontra associado a várias afeções no cão e no gato e, ao ser responsável pelo estabelecimento de um estado de imunossupressão, contribui de modo significativo para o agravamento da morbilidade e mortalidade dos doentes. No sentido de reverter a neutropénia e prevenir as suas consequências, podem ser administrados fatores estimuladores de colónias de granulócitos recombinantes humanos (rhG-CSF) que aceleram a produção e diferenciação dos neutrófilos na medula óssea e causam a sua saída para o sangue. Assim, esta dissertação teve como objetivo avaliar retrospetivamente a utilização de rhG-CSF em várias doenças em canídeos e felídeos, de modo a contribuir para um maior conhecimento do seu uso em medicina veterinária. Neste estudo, os rhG-CSF foram administrados a animais com neutropénia induzida pela infeção por parvovírus canino e felino (60,0%), por fármacos citotóxicos (20,0%) e hipoplasia da medula óssea (20,0%). A maioria destes animais apresentou-se com neutropénia grave (46,7%), seguida de neutropénia moderada (33,3%) e ligeira (20,0%). A utilização dos rhG-CSF foi avaliada através de hemogramas realizados antes da primeira administração e após 48 horas. Em todos os grupos foram encontrados aumentos significativos nas contagens absolutas dos leucócitos totais e neutrófilos. No grupo amostral de animais com infeção por parvovírus foi também observado um aumento significativo no número de monócitos, linfócitos e eosinófilos. Uma diminuição na contagem dos eritrócitos foi ainda encontrada no grupo de animais com infeção por parvovírus e mielotoxicidade secundária a fármacos citotóxicos, mas o seu significado é questionável. Como segunda parte deste estudo foi feita uma análise individual dos casos clínicos, na qual se verificou que a taxa de resposta aos rhG-CSF foi de 73,3%. Para além disto, foi ainda investigada a existência de associação entre a taxa de resposta e outras variáveis registadas, tendo-se encontrado uma associação com a etiologia (p = 0,041) e o desfecho clínico, classificado como alta médica ou óbito (p = 0,001). Apesar do pequeno tamanho da amostra estudada, os resultados da presente dissertação sugerem que a utilização de rhG-CSF em cães e gatos apresenta efeitos terapêuticos benéficos a nível hematológico, sendo bem tolerados quando administrados em protocolos de curta duração.
ABSTRACT - Contribution to the study of the use of granulocyte colony-stimulating factors in the management of diseases associated with neutropenia in dogs and cats: retrospective study of 30 clinical cases (2011 – 2016) - Neutropenia is a hematological finding that can be caused by a diversity of diseases in dogs and cats and, by being responsible for an immunocompromised state, contributes significantly to patient morbidity and mortality. In order to reverse neutropenia and prevent its consequences, human recombinant granulocyte colony-stimulating factors (rhG-CSF) can be used, which are drugs that increase neutrophil production and differentiation in the bone marrow and their release into the blood. The aim of this dissertation was to retrospectively evaluate the use of rhG-CSF in various clinical conditions in canine and feline patients, contributing to a greater knowledge of their use in veterinary medicine. In this study rhG-CSF were administrated to animals with neutropenia induced by canine and feline parvovirus infection (60,0%), by cytotoxic drugs (20,0%) and bone marrow hypoplasia (20,0%). The majority of these animals presented with severe neutropenia (46,7%), followed by moderate (33,3%) and mild neutropenia (20,0%). The use of these drugs was evaluated through complete blood counts performed before the first administration and after 48 hours. In all groups significant increases on total leukocyte and neutrophil counts were observed. In the sample group of animals with parvovirus infection a significant increase in the number of monocytes, lymphocytes and eosinophils was also found. A decrease in the number of erythrocytes was also seen in the group of animals with parvovirus infection and myelotoxicity secondary to cytotoxic drugs, but its meaning is questionable. As a second part of this study, an individual analysis of the clinical cases was made, which showed that the overall response rate to rhG-CSF was 73,3%. Moreover, associations between the response rate and other variables were investigated and it was encountered an association with etiology (p = 0,041) and clinical outcome, classified as hospital discharge or patient death (p = 0,001). Despite the small sample size, the results of the present dissertation suggest that the use of rhG-CSF in dogs and cats brings beneficial therapeutic effects on a hematological level and are well tolerated when administered in short protocols.
N/A
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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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GANDON, MICHONNEAU VERONIQUE. "Neutropenie et polyarthrite rhumatoide : a propos de 3 observations." Angers, 1991. http://www.theses.fr/1991ANGE1014.

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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 farmacología
Introducción: 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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Schuler, Ulrich, Susanne Bammer, Walter E. Aulitzky, Claudia Binder, Angelika Böhme, Gerlinde Egerer, Michael Sandherr, et al. "Safety and Efficacy of Itraconazole Compared to Amphotericin B as Empirical Antifungal Therapy for Neutropenic Fever in Patients with Haematological Malignancy." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-134972.

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Safety, tolerability and efficacy of itraconazole and amphotericin B (AMB) were compared for empirical antifungal treatment of febrile neutropenic cancer patients. Patients and Methods: In an open, randomised study, 162 patients with at least 72 h of antimicrobial treatment received either intravenous followed by oral itraconazole suspension or intravenous AMB for a maximum of 28 days. Permanent discontinuation of study medication due to any adverse event was the primary safety parameter. Efficacy parameters included response and success rate for both treatment groups. Results: Significantly fewer itraconazole patients discontinued treatment due to any adverse event (22.2 vs. 56.8% AMB; p < 0.0001). The main reason for discontinuation was a rise in serum creatinine (1.2% itraconazole vs. 23.5% AMB). Renal toxicity was significantly higher and more drug-related adverse events occurred in the AMB group. Intention-to-treat (ITT) analysis showed favourable efficacy for itraconazole: response and success rate were both significantly higher than for AMB (61.7 vs. 42% and 70.4 vs. 49.3%, both p < 0.0001). Treatment failure was markedly reduced in itraconazole patients (25.9 vs. 43.2%), largely due to the better tolerability. Conclusions: Itraconazole was tolerated significantly better than conventional AMB and also showed advantages regarding efficacy. This study confirms the role of itraconazole as a useful and safe agent in empirical antifungal therapy of febrile neutropenic cancer patients
Hintergrund: Es wurden die Sicherheit, Verträglichkeit und Wirksamkeit von Itraconazol und Amphotericin B (AMB) in der antimykotischen Therapie der persistierend febrilen Neutropenie verglichen. Patienten und Methoden: In einer offenen, randomisierten Studie erhielten 162 Patienten mit mindestens 72-stündiger antibiotischer Therapie entweder Itraconazol (erst intravenös, dann oral) oder AMB (intravenös) für maximal 28 Tage. Primärer Sicherheitsparameter war die dauerhafte Unterbrechung der Studienmedikation aufgrund von Nebenwirkungen. Die Wirksamkeitsparameter umfassten die Ansprech- und Erfolgsrate für beide Behandlungsgruppen. Ergebnisse: Signifikant weniger Itraconazol-Patienten brachen die Behandlung wegen Nebenwirkungen ab (22,2 vs. 56,8% AMB; p < 0,0001). Hauptursache für Studienabbrüche war der Anstieg des Serum-Kreatinin-Spiegels (1,2% Itraconazol vs. 23,5% AMB). Nephrotoxische und weitere Nebenwirkungen traten im AMB-Studienarm signifikant häufiger auf. Intention-to-Treat (ITT)-Analysen zeigten eine bessere Wirksamkeit von Itraconazol: Ansprech- und Erfolgsrate waren signifikant höher als unter AMB (61,7 vs. 42% und 70,4 vs. 49,3%, beide p < 0,0001). Behandlungsversagen trat bei Itraconazol-Patienten merklich weniger auf (25,9 vs. 43,2%). Schlussfolgerungen: Die Verträglichkeit von Itraconazol war signifikant höher als beim herkömmlichen AMB. Itraconazol zeigte ebenfalls Vorteile in der Wirksamkeit. Diese Studie bestätigt die Rolle von Itraconazol als sinnvolles und sicheres Medikament in der empirischen antimykotischen Therapie von fiebrigen neutropenischen Tumorpatienten
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Fagnani, Renata 1973. "Estudo epidemiologico das infecções hospitalares dos pacientes com doenças onco-hematologicas ou anemia aplastica atendidos no Hospotal das Clinicas-Unicamp." [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313471.

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Orientador: Plinio Trabasso
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Os avanços nas técnicas de diagnósticos e na terapêutica têm aumentado a sobrevida e o número de indivíduos com alterações imunológicas, sendo a neutropenia fator predisponente para IH. Este estudo avaliou a ocorrência de IH nos pacientes com DOH ou AA acompanhados consecutivamente no HC UNICAMP, tendo como objetivos determinar a densidade de incidência, as topografias, os agentes etiológicos das IH e identificar os fatores de risco para ocorrência de episódios febris. Foi realizado estudo observacional prospectivo de investigação epidemiológica, através da busca ativa de casos e coleta sistemática de dados no período de outubro de 2001 a outubro de 2003. No período foram acompanhados 352 pacientes que apresentaram 794 internações, sendo diagnosticados 245 episódios febris, onde foram identificados 87 (35,5%) casos de FOI e 158 (64,5%) de infecções clínicas ou microbiologicamente documentadas. A mediana de dias de internação hospitalar foi superior para os pacientes que apresentaram episódios febris. A taxa de utilização dos dispositivos invasivos foi de 4,18 e 8,9 para VM e SVD e 48,7/ 100 pacientes-dia para os CVC. Os dispositivos invasivos, VM, SVD, SH e HIC foram identificados no estudo como risco para IH. Ao realizarmos a análise bivariada entre os graus de neutropenia (NL, NM, NG) prévios aos diagnósticos dos episódios febris; o estudo demonstrou valores significativos em relação a FOI, ICS, PN, CSEP, PELE, GI e VASC. No estudo foram diagnosticadas: ICS (n=69), RESP (n=32), ITU (n=17), PELE (n=10), VASC (n=9), EENT (n=9) e CSEP (n=7). Ao realizarmos os cálculos de densidade de incidência das topografias estratificadas pelo grau de neutropenia, o índice de IH foi superior no período de neutropenia grave. Cento e dez agentes etiológicos foram isolados dentre as ICS e ITU, sendo 56,36% bactérias Gram-negativas, 37,27% bactérias Gram-positivas, 5,45% leveduras e 0,9% fungos filamentosos. A taxa de mortalidade da população estudada foi de 14,8/ 1000 pacientes-dias. ICS, CSEP e PN foram topografias de risco para o óbito. Este estudo demonstrou o risco dos dispositivos invasivos e da neutropenia para ocorrência da IH e identificou predominância de bactérias Gram-negativas na população do estudada
Abstract: Diagnostic and therapeutic advances have led to an increased number of individuals with immunological alterations being neutropenia one of the most important predisposing factor for infections. A prospective observational cohort study, from October 2001 to October 2003 was conducted for determine the incidence, sites and etiological agents and to verify if granulocytopenia or invasive devices are risk factors for nosocomial infections (NI) in patients with onco-hematologic diseases or aplastic anemia. There were 352 patients, corresponding to 794 hospitalizations. There were 245 febrile episodes, being 158 (64.5%) of clinically or microbiologically documented infections and 87 (35.5%) of fever of unknown origin (FUO). Infections were diagnosed as BSI (n=69); LRI (n=32); UTI (n=17); SST (n=10); VASC (n=9); EENT (n=9); CSEP (n=7) and GI (n=7). The median length of stay was superior among patients with febrile episodes. Microorganisms were recovered from 86 cases, accounting for 110 microorganisms, being 56.36% gram-negative bacteria; 37.27% gram-positive bacteria; 5.45% yeast and 0.9% filamentous fungi. Granulocytopenia was found to be risk factor in bivariate analysis for FUO (p<0.01); CSEP (p=0.019); SST (p=0.019); GI (p=0.01); PNEU (p=0.023); BSI (p<0.01) and VASC (p=0.046). The mortality rate was 14.8/1000 patients-day. It was concluded that neutropenia and invasive devices were risk factors for NI; gram-negative bacteria predominate
Mestrado
Ciencias Basicas
Mestre em Clinica Medica
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26

Brossard, Gilles. "Pharmacocinétique du tienam chez le sujet neutropénique." Bordeaux 2, 1988. http://www.theses.fr/1988BOR25350.

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27

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.

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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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28

Persson, Lennart. "Neutropenic fever during treatment of hematological malignancy : etiology and diagnostics /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-194-6/.

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29

SAPRA, ADYA. "Genomic Instability in Severe Congenital Neutropenia, a Leukemia Predisposition Syndrome." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5639.

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Severe congenital neutropenia (SCN) is a rare blood disorder characterized by abnormally low levels of circulating neutrophils. Mutations in multiple genes like neutrophil elastase gene (ELANE) and granulocyte colony stimulating factor receptor (CSF3R) may cause SCN. The treatment of choice for SCN is the administration of granulocyte-colony stimulating factor (G-CSF) which elevates the neutrophil count and hence improves the survival and quality of life. Long term survivorship on G-CSF is however linked to development of MDS (myelodysplastic syndrome)/AML (acute myeloid leukemia). About 70% of MDS/AML patients acquire nonsense mutations affecting the cytoplasmic domain of CSF3R. In this project, we hypothesized that this coding region of CSF3R constitutes a hotspot, vulnerable to mutations resulting from excessive oxidative stress or endoplasmic reticulum (ER) stress. We used the murine Ba/F3 cell line to study the effect of induced oxidative or ER stress on the mutation rate in our hypothesized hotspot of the exogenous human CSF3R, the corresponding region in the endogenous Csf3r, and a leukemia-associated gene Runx1. Ba/F3 cells transduced with the cDNA for partial C-terminal of CSF3R fused in-frame with a Green Fluorescent Protein (GFP) tag was subjected to cellular stress inducing mutagen treatment for a prolonged period of time (30 days). The amplicon based targeted deep sequencing data for days 15 and 30 samples show that although there was increased mutagenesis observed in all genes, there were more mutations in the GFP region as compared to the GC-rich partial CSF3R region. Our findings also indicate that there is no correlation between the stress-inducing chemical treatments and mutagenesis in Ba/F3 cells. Thus, we conclude that there are other mechanisms to acquired mutations of CSF3R that help drive the evolution of SCN to MDS/AML. To test this hypothesis, further experiments using unique barcoding system are in progress to characterize the clonal competition between different mutant CSF3R and ELANE expressing cell lines. This study will shed further light on the selection advantage that is provided to cells because cooperativity between mutations in different genes.
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30

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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31

Mouchache, Seye Myriam. "La neutropénie fébrile a-t-elle une incidence sur le pronostic des cancers bronchiques à petites cellules disséminés traités par PEVEP dose standard versus PEVEP haute dose + Gm-CSF." Montpellier 1, 1997. http://www.theses.fr/1997MON11103.

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32

Hadley, A. G. "The clinical significance of anti-leucocyte antibodies." Thesis, University of Oxford, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.375237.

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33

VALLET, MESNIER BENEDICTE. "Hypogammaglobulinemie commune variable et neutropenie auto-immune : a propos d'une observation ; revue de la litterature." Besançon, 1991. http://www.theses.fr/1991BESA3024.

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34

BERNAERT, FRANCOIS-REGIS. "Etude pharmacocinetique de l'amikacine dans les neutropenies severes : inferieures a 500 polynucleaires neutrophiles par mm3." Amiens, 1988. http://www.theses.fr/1988AMIEM022.

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35

McBride, Ali, Sanjeev Balu, Kim Campbell, Mohan Bikkina, Karen MacDonald, and Ivo Abraham. "Expanded access to cancer treatments from conversion to neutropenia prophylaxis with biosimilar filgrastim-sndz." FUTURE MEDICINE LTD, 2017. http://hdl.handle.net/10150/626506.

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Aim: Biosimilar medicines offer significant cost-savings potential over their reference products, which can be re-allocated to provide access to other cancer treatments on a budget-neutral basis. Methods: Simulation study using cost data for the USA under consideration of several prophylaxis patterns. Results: Potential savings from conversion from reference filgrastim to biosimilar filgrastim-sndz are significant. These savings expand budget-neutral access to novel immunotherapies (obinutuzumab; pembrolizumab) or supportive care (filgrastim-sndz). Conclusion: The combination of biosimilar savings and expanded access increases the value of cancer care as the same supportive care is provided at lower cost, additional cancer care is enabled at no additional cost, and more patients will have access to cancer care.
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36

Lam, M. F. "Meta-analysis of different anti-fungal prophylactic treatments in neutropenic patients." Click to view the E-thesis via HKUTO, 2002. http://sunzi.lib.hku.hk/hkuto/record/B3197062X.

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37

Lam, M. F., and 林文輝. "Meta-analysis of different anti-fungal prophylactic treatments in neutropenic patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B3197062X.

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38

Trümpler, Urs Manuel. "Human lactoferrin: a potential agent for antibacterial prophylaxis in neutropenic patients /." [S.l : s.n.], 1987. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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39

Wicki, Silvia Keisker André. "Prädiktion von Fieber in Neutropenie bei Kindern unter Chemotherapie wegen Krebserkrankung /." Bern : [s.n.], 2007. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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40

Haenel, Claude. "Neutropenie cyclique et traitement par rg-csf : a propos d'une observation." Université Louis Pasteur (Strasbourg) (1971-2008), 1991. http://www.theses.fr/1991STR1M217.

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41

Barnes, R. A. "An investigation of the problem of invasive aspergillosis in neutropenic patients." Thesis, Imperial College London, 1988. http://hdl.handle.net/10044/1/46955.

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42

Lee, Yarim. "Disease-on-the-dish modeling of ELANE start codon mutations in human severe congenital neutropenia." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1626956562178187.

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43

Gustafsson, Hanne. "sPLA2-IIA: potentiell biomarkör för bakterieinfektion hos patienter med neutropen feber?" Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58323.

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44

Prentice, H. Grant, Denis Caillot, B. Dupont, F. Menichetti, and Ulrich Schuler. "Oral and Intravenous Itraconazole for Systemic Fungal Infections in Neutropenic Haematological Patients: Meeting Report." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-137527.

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Effective prevention, or treatment, of invasive fungal infection in the neutropenic patient has hitherto been unsatisfactory because of either an inadequate anti-fungal spectrum of the agent or important toxicity. Itraconazole is effective against a broad spectrum of the opportunistic pathogens seen in Europe and North America. Prior problems with absorption, e.g. in the marrow transplant recipient, have been overcome with the introduction of an oral solution and an i.v. preparation. The deliberations of an expert meeting held in June, 1998 include recommendations on which patient requires one of these new preparations based on clinical trials, the dose and route. Important drug interactions are also detailed
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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45

Schuler, Ulrich, Susanne Bammer, Walter E. Aulitzky, Claudia Binder, Angelika Böhme, Gerlinde Egerer, Michael Sandherr, et al. "Safety and Efficacy of Itraconazole Compared to Amphotericin B as Empirical Antifungal Therapy for Neutropenic Fever in Patients with Haematological Malignancy." Karger, 2007. https://tud.qucosa.de/id/qucosa%3A27609.

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Safety, tolerability and efficacy of itraconazole and amphotericin B (AMB) were compared for empirical antifungal treatment of febrile neutropenic cancer patients. Patients and Methods: In an open, randomised study, 162 patients with at least 72 h of antimicrobial treatment received either intravenous followed by oral itraconazole suspension or intravenous AMB for a maximum of 28 days. Permanent discontinuation of study medication due to any adverse event was the primary safety parameter. Efficacy parameters included response and success rate for both treatment groups. Results: Significantly fewer itraconazole patients discontinued treatment due to any adverse event (22.2 vs. 56.8% AMB; p < 0.0001). The main reason for discontinuation was a rise in serum creatinine (1.2% itraconazole vs. 23.5% AMB). Renal toxicity was significantly higher and more drug-related adverse events occurred in the AMB group. Intention-to-treat (ITT) analysis showed favourable efficacy for itraconazole: response and success rate were both significantly higher than for AMB (61.7 vs. 42% and 70.4 vs. 49.3%, both p < 0.0001). Treatment failure was markedly reduced in itraconazole patients (25.9 vs. 43.2%), largely due to the better tolerability. Conclusions: Itraconazole was tolerated significantly better than conventional AMB and also showed advantages regarding efficacy. This study confirms the role of itraconazole as a useful and safe agent in empirical antifungal therapy of febrile neutropenic cancer patients.
Hintergrund: Es wurden die Sicherheit, Verträglichkeit und Wirksamkeit von Itraconazol und Amphotericin B (AMB) in der antimykotischen Therapie der persistierend febrilen Neutropenie verglichen. Patienten und Methoden: In einer offenen, randomisierten Studie erhielten 162 Patienten mit mindestens 72-stündiger antibiotischer Therapie entweder Itraconazol (erst intravenös, dann oral) oder AMB (intravenös) für maximal 28 Tage. Primärer Sicherheitsparameter war die dauerhafte Unterbrechung der Studienmedikation aufgrund von Nebenwirkungen. Die Wirksamkeitsparameter umfassten die Ansprech- und Erfolgsrate für beide Behandlungsgruppen. Ergebnisse: Signifikant weniger Itraconazol-Patienten brachen die Behandlung wegen Nebenwirkungen ab (22,2 vs. 56,8% AMB; p < 0,0001). Hauptursache für Studienabbrüche war der Anstieg des Serum-Kreatinin-Spiegels (1,2% Itraconazol vs. 23,5% AMB). Nephrotoxische und weitere Nebenwirkungen traten im AMB-Studienarm signifikant häufiger auf. Intention-to-Treat (ITT)-Analysen zeigten eine bessere Wirksamkeit von Itraconazol: Ansprech- und Erfolgsrate waren signifikant höher als unter AMB (61,7 vs. 42% und 70,4 vs. 49,3%, beide p < 0,0001). Behandlungsversagen trat bei Itraconazol-Patienten merklich weniger auf (25,9 vs. 43,2%). Schlussfolgerungen: Die Verträglichkeit von Itraconazol war signifikant höher als beim herkömmlichen AMB. Itraconazol zeigte ebenfalls Vorteile in der Wirksamkeit. Diese Studie bestätigt die Rolle von Itraconazol als sinnvolles und sicheres Medikament in der empirischen antimykotischen Therapie von fiebrigen neutropenischen Tumorpatienten.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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46

Bittan, Carole. "Impact du G-CSF dans les neutropénies chimio-induite chez les enfants en rechute de leucémies aigue͏̈s lymphoblastiques." Paris 5, 1994. http://www.theses.fr/1994PA05P216.

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47

Forke, Adrian [Verfasser]. "Sind atypische Mykobakterien im Trinkwasser eine Gefahr für neutropene Patienten? / Adrian Forke." Ulm : Universität Ulm. Medizinische Fakultät, 2013. http://d-nb.info/1036454444/34.

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48

Schädel, Jana [Verfasser]. "Effekt eines multimodalen Antimicrobial Stewardship-Programms bei Fieber in Neutropenie / Jana Schädel." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1113011955/34.

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49

Ceesay, Muhammed Mansour. "Diagnosis and management of invasive aspergillosis in adult neutropenic haemato-oncology patients." Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/diagnosis-and-management-of-invasive-aspergillosis-in-adult-neutropenic-haematooncology-patients(b14bc6a9-90bc-4434-9d93-cb0fe1a09cfe).html.

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Background: Invasive fungal disease (IFD) is difficult to diagnose. For clinical trials the European Organisation for Research in Treatment of Cancer (EORTC) and the Mycology Study Group (MSG) criteria are useful but there are few data on their value in clinical practice. The aims of this study were to: (1) investigate the incidence and risk factors of IFD; (2) assess the utility of galactomannan (GM), β-D glucan (BDG), the UK consensus fungal PCR, and lateral flow device (LFD) assays together with the safety and feasibility of biopsy; (3) assess the role of cytokines in the diagnosis and prognosis of IFD; (4) establish the prevalence of baseline CT abnormalities, and assess diagnostic CT features and spectrum of radiological signs. Methods: Patients (N=203) were recruited prospectively and followed for a median (range) of 556 (12-730) days after chemotherapy or haematopoietic stem cell transplantation. Chest CT, Karnofsky score (KS), serum GM, and cytokine profiles were performed at baseline; during admission twice-weekly GM assays were performed on all patients. BDG, serum and whole blood consensus PCR, and LFD assays were performed on a selection of samples from different IFD categories. Neutropenic sepsis refractory to antimicrobials for ≥4 days triggered diagnostic CT and biopsy where feasible. All patients were on antifungal prophylaxis from admission. The revised EORTC/MSG criteria were used to diagnose IFD. Results: The cumulative incidence of proven/probable IFD at 6, 12, and 24 months was 16, 19, and 21%, respectively. Using GM or BDG alone (plus host and clinical evidence) the apparent incidence of proven/probable IFD was 11 and 16% respectively. The median time from index treatment to onset of IFD was 142, 17, and 41 days for proven mould, proven candida and probable IFD, respectively (P < 0.001). The 2-year overall survival (95% CI) were 45 (29-61)% for proven/probable IFD vs. 87 (77-97)% for no evidence of IFD (P < 0.001). Baseline CT abnormalities were found in 76 (38%) patients, 19 of which were EORTC signs. Risk factors for IFD on multivariate Cox regression were: EORTC CT signs (Hazard ration [HR] 4.3; 95% CI 1.9-9.8; P<0.001), IL-2R >834 pg/ml (HR 2.3; 95% CI 1.1-5.1; P=0.037), MCP-1 >841 pg/ml (HR 2.7; 95% CI 1.2-6.1; P=0.016), and KS <90 (HR 2.1; 95% CI 1.1-4.2; P=0.034) at baseline as well as monocytopenia >10 days (HR 2.6; 95% CI 1.3-5.4; P=0.009) and bacteraemia (HR 2.5; 95% CI 1.2-5.0; P=0.013). The sensitivity, specificity, PPV, and NPV for GM was 54, 71, 82, and 39%, respectively; coresponding values for BDG were 79, 55, 83, and 49%. The proportion of cases identified by both tests was 38%. The sensitivity of biopsy was 35% and PCR and LFD were less sensitive but more specific than GM or BDG. Conclusions: A multi-faceted approach is required to improve the diagnostic accuracy of IFD. No single assay was able to detect all the cases but the combination of BDG and GM seem to offer the best biomarker combination. Baseline chest CT, KS, and cytokine profile as well as monocytopenia and bacteraemia are important risk factors. (ClinicalTrials.gov number NCT00816088).
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50

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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