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Empirical antimicrobial treatment in haemato-/oncological patients with neutropenic sepsis.

Neutropenic sepsis in haemato-/oncological patients is a medical emergency, as infections may show a fulminant clinical course. Early differentiation between sepsis and febrile neutropenic response often proves to be challenging. To assess the severity of the illness, different tools, which are discussed in this article, are available. Once the diagnosis has been established, the correct use of early empirical antibiotic and antifungal treatment is key in improving patient survival. Therefore, profound knowledge of local resistance patterns is mandatory and carefully designed antibiotic regime

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… If history of a type IV penicillin allergy (ie, drug exanthema) is present or suspected for the patient in question, alternatively an initial cefepime therapy with escalation to cefepime/linezolid is advisable. … If no pathogen has been detected, depending on the initial course of treatment, cefepime and subsequently aztreonam might be considered as the latter has shown in vitro activity against metallo-β-lactamase-producing pathogens despite its slow hydrolysation by New Delhi metallo-β-lactamase (NDM). 35 36 …

Sphingobacterium multivorum cellulitis: case report and mini-review.

BACKGROUND: Sphingobacterium multivorum is a gram-negative, non-fermentative, oxidase-positive, catalase-positive bacillus. S multivorum has been identified in urinary tract infections, respiratory tract infections, spontaneous peritonitis, septic arthritis, meningitis, bacteraemia and septic shock. Ours is the second case of skin and soft tissue infection sustained by S. multivorum (a case of necrotizing fasciitis with septic shock has been previously reported). In this paper, we furnish a review of the literature on all the cases of S multivorum described in the medical literature (with the

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… Antibiotic susceptibility testing ( Table 2 ) revealed that the isolate was resistant to piperacillin-tazobactam, ceftazidime, and imipenem but susceptible to cefepime and meropenem. Among aminoglycosides, resistance was observed for amikacin and tobramycin, but gentamicin remained susceptible. … Hydrolysis of imipenem, meropenem, ceftazidime, and cefepime by multiresistant nosocomial strains of Sphingobacterium multivorum. Eur J Clin Microbiol Infect Dis. 1997;16:178–181. doi: 10.1007/BF01709484. 8. Singer M., Deutschman C.S., Seymour C.W., et al. …

Nutritionally variant streptococci bacteremia in cancer patients: a retrospective study, 1999-2014.

BackgroundNutritionally variant Streptococci (NVS), Abiotrophia and Granulicatella are implicated in causing endocarditis and blood stream infections more frequently than other sites of infection. Neutropenia and mucositis are the most common predisposing factors for infection with other pathogens in cancer patients. In this study, we investigated the clinical characteristics of NVS bacteremia in cancer patients and identified risk factors and outcomes associated with these infections.Materials and methodsWe retrospectively reviewed all cases of NVS bacteremia occurring from June 1999 to April

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… . | Age (years) | Gender | Malignancy | Duration of Bacteremia (Days) | Duration of Neutropenia (Days) | Treatment | Outcome 1 | 60 | M | CML | 1 | - | Vancomycin, Levofloxacin | Survived 2 | 58 | M | MM | 1 | - | Vancomycin, Cefepime | Deceased due to complications 3 | 76 | M | AML | 1 | 22 | Vancomycin … | Deceased due to complications 4 | 27 | F | AML | 1 | 34 | Vancomycin, Tobramycin | Deceased at hospice 5 | 50 | F | NHL | 1 | - | Bactrim | Deceased due to complications 6 | 64 | F | NHL | 1 | 7 | Vancomycin, Cefepime | Survived 7 | 86 | M | Bladder cancer | 1 | - | Ampicillin/sulbactam, Levofloxacin …

FDA-Approved Drugs Containing Amide Functionality in the Last Five Years (2021-2025): Pharmaceutical Use, Trends and Synthetic Approaches.

The amide functional group remains a cornerstone of medicinal chemistry, serving as an indispensable scaffold in the design of modern therapeutics. This review presents an analysis of FDA-approved drugs (small molecules and peptides with MW ®), amides form the structural backbone of peptidomimetics, enabling high-affinity binding to a viral protease. In precision oncology, as seen with adagrasib (Krazati®), the amide acts as a critical, metabolically stable linker that positions a covalent warhead for selective inhibition of a mutant kinase. This analysis underscores that amide's unique combin

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… Cefepime/Enmetazobactam Cefepime 74 /enmetazobactam 75 , marketed under the brand name Exblifep ® ( Figure 58 ), was approved by the FDA in February 2024. … Cefepime is a fourth-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. Enmetazobactam is a novel β-lactamase inhibitor that protects cefepime from degradation by certain β-lactamases, including extended-spectrum β-lactamases (ESBLs) [ 237 ]. …

Bilateral Intertrochanteric Femur Fractures in a Paraplegic Patient: A Case Report.

Bilateral intertrochanteric (IT) femur fractures are rare, and appropriate evaluation and treatment can vary depending on concurrent patient comorbidities. Even less has been described for patients with bilateral IT fractures with pre-existing paraplegia. This case report describes the unique case of a 72-year-old paraplegic female who presented with bilateral IT femur fractures due to a wheelchair accident. The patient was treated with single-stage bilateral cephalomedullary nail fixation so she could effectively transfer to and from the wheelchair with less pain and a greater chance of fract

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… Cefepime was recommended due to her history of a recent urinary tract infection, prior MRSA infections, and stage IV sacral decubitus ulcer. Her pre-operative hemoglobin was 12.2 g/dL, and she was cleared by her ancillary medical teams for orthopedic surgical intervention. … An electroencephalogram demonstrated moderate to severe encephalopathy, and mounting concern for drug-induced neurotoxicity, which led to her antibiotics being switched from cefepime to Zosyn. …

Best Practices in the Management of Infectious Complications for Patients With Cancer: Management of Febrile Neutropenia.

Managing infection in patients with neutropenia is a difficult challenge, as fever is often the only clinical symptom. At JADPRO Live 2022, Kyle C. Molina, PharmD, BCIDP, AAVHIP, of the University of Colorado Hospital, discussed the epidemiology and pathophysiology associated with febrile neutropenia in patients with cancer. He reviewed appropriate treatment settings and empiric antimicrobial regimens for a patient and how to formulate a plan to safely de-escalate and target therapy for patients with febrile neutropenia.

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… For patients with a relatively uncomplicated presentation and low risk of colonization with resistant organisms, a relatively narrow-spectrum antibiotic such as cefepime may be used initially and then broadened if necessary. … However, if the institution has a high prevalence of resistance to cefepime, a carbapenem may be needed even for uncomplicated patients. …

Clinical Outcome of Febrile Neutropenia and Associated Factors Among Adult Patients with Cancer Treated at Ethiopian Oncology Centers: A Retrospective Observational Study.

IntroductionFebrile neutropenia (FN) is a major cause of dose-limiting complications in cancer treatment that predisposes patients to serious infections. Despite advancements in therapies, including empirical and definitive antibiotics, FN remains a major morbidity and mortality issue among patients with cancer undergoing cancer treatment. Little is known about the 30-day all-cause mortality rates from FN in Ethiopia, particularly in the Northwest Ethiopia oncology centers.MethodsThis retrospective cross-sectional study was conducted via chart review without direct patient contact at two North

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… In our study, combination therapy (80.3%) was the most common treatment type, with ceftazidime + vancomycin (30.7%) being the most frequently administered combination antibacterial therapy, followed by cefepime + vancomycin (16.1%). … The most common monotherapeutic regimen was cefepime. We found that 30-day all-cause mortality was associated with older age, low MASCC score, hypoalbuminemia, lymphopenia, and elevated GGT levels. …

Safety and feasibility of outpatient autologous stem cell transplantation in pediatric patients with primary central nervous system tumors.

High-dose chemotherapy with autologous hematopoietic stem cell transplantation (autoHSCT) is a well-established treatment for pediatric central nervous system (CNS) tumors. Given the risks of toxicity and infection, pediatric autoHSCT has been historically performed on hospitalized children. As our practice evolved, some patients were transplanted as outpatients. We performed a retrospective cohort analysis of 37 patients who received 90 transplant procedures (49 outpatient and 41 inpatient) at Children's Hospital Colorado. The most common primary diagnosis was medulloblastoma (51.4%). Of the

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… In the inpatient setting, bacterial prophylaxis was intravenous (IV) meropenem or cefepime starting when the Absolute Neutrophil Count (ANC) was < 500/mm 3 or with the development of fever. … Table 4 Infectious complications of outpatient and inpatient transplant episodes Outpatient transplant episodes ( n = 49) Inpatient transplant episodes ( n = 41) p Value Antibiotics initiated, n (%) Meropenem 21 (53.8) 35 (87.5) Cefepime 14 (35.9) 3 (7.5) 0.01 Ceftazidime 4 (10.3) 1 (2.5) Vancomycin …

Hemophagocytic Lymphohistiocytosis and Pancreatic Cancer: A Rare Association.

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) or hemophagocytic syndrome (HPS) is a life-threatening and relatively rare condition … olimus was held, and the patient was started on broad-spectrum antibiotics including vancomycin and cefepime for sepsis of unknown origin along with vasopressors for hypotension, requiring admission to the medical intensive care unit. Blood and urine cultures were collected on admission which remained negative throughout the course of hospital. CA19-9 leve …

Infection related membranoproliferative glomerulonephritis secondary to anaplasmosis: A case report.

BACKGROUND: Anaplasmosis is a tick-borne disease with a range of clinical manifestations, from a flu-like illness with fever and myalgias to a severe systemic disease with multisystem organ failure. Although renal involvement is not a common presentation, there have been few cases reporting acute kidney injury from Anaplasmosis. CASE SUMMARY: We present a 55-year-old female with anaplasmosis who developed acute kidney injury due to membranoproliferative glomerulonephritis (MPGN). The patient originally presented with cough and shortness of breath. She was admitted to the hospital with a diagn

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… TREATMENT She was admitted to the hospital and started on empiric antibiotics for community-acquired pneumonia with cefepime and metronidazole. Her baseline creatinine was 0.6 to 1 mg/dL but during the hospital course she developed an acute kidney injury, with her creatinine reaching 1.6 mg/dL. … On day 6, renal function recovered to baseline, but the leukocyte count remained persistently elevated, despite empirical treatment with cefepime and metronidazole. Her respiratory status did not improve, and a repeat chest CT was performed on day 7, revealing persistent bilateral opacities. …

Multidisciplinary Exploration of Unknown Oral Lesions With Accompanying Oral Verrucas of the Tongue: A Case Report.

A 64-year-old African American male with a history of hypertension and type II diabetes mellitus presented with unexplained upper lip lacerations after several frequent episodes of hemoptysis. Following the upper lip lacerations were several weeks of intermittent unknown episodic fevers. The patient, challenged by impaired mobility, exhibited an array of symptoms, including severe upper lip pain with lacerations and white patches on the tongue. Laboratory findings indicated thrombocytopenia and anemia, with positive tests for both influenza A and B. Despite completing Tamiflu, the patient expe

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… This began with cefepime 2 g intravenous (IV) every 12 hours for three days initially. After completion and no change in presentation, the patient was given meropenem 1 g IV every eight hours. … However, considering the patient's prior administration of cefepime, meropenem, and amoxicillin, the probability of a UTI was considered minimal [ 12 ]. …

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… R1979: Comparison of in vitro activity of cefepime alone or in combination with sulbactam against clinical strains of multi-drug resistant Acinetobacter spp. K.L. Leuthner, M.J. Rybak, H.S. Sader, R.N. … The objective of this study was to determine the effect of cefepime (C) alone and in combination with sulbactam (S) against MDR-A isolates in an in vitro pharmacodynamic model. Methods : Three clinical strains of MDR-A: 15-11270A; 86-3473 and 15-2016 were used. …

Атипичные презентации Acolovir-Resistant Herpes Simplex Virus в иммунокомпромиссированных пациентах: Серия дел.

Инфекции, связанные с вирусом герпеса (HSV), у иммунокомпромиссированных пациентов могут иметь атипичные представления - от грануломатных до линейных эрозийных повреждений - и превращаться в рефракторную и стандартную терапию. Мы сообщаем three :: случаи некротизации категорической инфекции HSV у иммунокомпромиссированных пациентов с гематологическими малигнациями или предшествующими химиотерапиями, все из которых имеют нетипичные и рефракторные проявления заболевания. One дело касалось 53-year-old :: пациентка с реанимацией/рефрактом острой миэлоидной лейкемией (АМЛ), разработавшая некротизир

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… Table 1 Clinical course, diagnostic findings, and therapeutic escalations HSV: Herpes simplex virus; EEG: Electroencephalogram; PCR: Polymerase chain reaction; EBV: Epstein–Barr virus Hospital Day | Event | Therapy 0 | Admission: fever + buttock plaque; CT/MRI shows abscess/myositis | Clindamycin → cefepime … In response, cefepime and voriconazole were started to cover gram-negative and fungal pathogens. …

Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).

To ensure the safety of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT), evidence-based recommendations on infectious complications after HDC/ASCT are given. This guideline not only focuses on patients with haematological malignancies but also addresses the specifics of HDC/ASCT patients with solid tumours or autoimmune disorders. In addition to HBV and HCV, HEV screening is nowadays mandatory prior to ASCT. For patients with HBs antigen and/or anti-HBc antibody positivity, HBV nucleic acid testing is strongly recommended for 6 months after HDC/ASCT or for the durati

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… In summary, AGIHO strongly recommends to use single-agent broad-spectrum Pseudomonas -active antibiotics such as piperacillin/tazobactam, ceftazidime, cefepime, meropenem or imipenem/cilastatin as first line antibiotic therapy [ 18 , 84 ]. … Cefozopran, meropenem, or imipenem-cilastatin compared with cefepime as empirical therapy in febrile neutropenic adult patients: a multicenter prospective randomized trial. J Infect Chemother. 2015;21(1):16–22. doi: 10.1016/j.jiac.2014.08.026. 89. …

Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases.

Two cases of Strongyloides stercoralis hyperinfection are described. Both patients were expatriates from the Indian subcontinent, and reported the use of corticosteroids. The first patient presented with severe pulmonary disease that necessitated respiratory support, followed by acute abdomen and intestinal obstruction and he succumbed to these diseases. The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease. The clinical features of S stercoralis hyperinfection are nonspe

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… Sputum culture grew P aeruginosa for which he was given intravenous cefepime and ciprofloxacin. Sputum smear for acid fast bacilli (AFB) was negative. … He was started empirically on intravenous ampicillin 2 gm every 4 hours, cefepime 2 gm every 8 hours for possible meningitis, and ivermectin was restarted. Later on blood and CSF cultures came to be negative; however, urine and endotracheal cultures grew P aeruginosa . …

Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting.

PurposeSepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients.Materials and methodsRetrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed.ResultsA total of 169 neutropenic episode

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… They have used single-agent cefepime or piperacillin-tazobactam/tigecycline combination as empirical agents. Thirty seven percent of neutropenic episodes in our cohort ended up as inpatients because of sepsis. … Furthermore, we might have to use single-agent piperacillin tazobactam and also rotate it with cefepime to reduce emergence of resistance to aminoglycosides as reported by others. 48 In conclusion, to our knowledge, this is the only documented study related to outcome and successful applicability of …

Predominance of Non-carbapenemase Producing Carbapenem-Resistant Enterobacterales in South Texas.

BackgroundCarbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the South Texas region.Materials and methodsWe compared the clinical, genotypic, and phenotypic profiles of carbapenemase producing Enterobacterales (CPE) with those of non-carbapenemase producers (NCPE) isolated from South Texas, United States between 2011 and 2019. Molecular characteristics and resistance

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… Comparatively, CPE maintained higher susceptibility to older generation tetracyclines (doxycycline and minocycline) compared to NCPE (69 and 89% vs 41 and 52%, respectively); whereas, NCPE isolates maintained higher susceptibility to cefepime compared to CPE (41% vs. 19%). … CPE, carbapenemase-producing Enterobacterales ( n = 38), NCPE, non-carbapenemase-producing Enterobacterales ( n = 58); AMI, Amikacin; AZT, Aztreonam, CIP, Ciprofloxacin; DOX, Doxyclicline; ERT, Ertapenem; FEP, Cefepime; FOT, Cefotetan; GEN, Gentamicin; MEM, Meropenem; MIN, Minocycline; TAZ, Ceftazidime …

Nanovesicular Drug Delivery Systems for Overcoming Antibiotic Resistance.

Despite the early success of treating bacterial infections with antibiotics, resistance development has become a global problem. Treatment of organisms that have become resistant to common antibacterial agents is challenging and can cause severe and extended illness, longer hospital stays, and increased medical costs. Bacteria may develop antibiotic resistance by multiple biochemical pathways, including target-site gene mutations, decreased permeability, drug uptake or efflux mechanisms that remove the drug from the host cells, and alterations in metabolic pathways. Several strategies to overc

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… | To determine the antimicrobial activity of a liposomal formulation of cefepime against Escherichia coli | Both formulations showed similar antibacterial activity against the Escherichia coli strain | [ 36 ] Azithromycin | To assess the effect of liposomal azithromycin in treating cervicovaginal infections … Bactericidal activity of cefepime encapsulated into cationic liposomes. Moyá ML, López-López M, Lebrón JA, et al. Pharmaceutics. 2019;11:69. doi: 10.3390/pharmaceutics11020069. 37. Azithromycin-liposomes as a novel approach for localized therapy of cervicovaginal bacterial infections. …

Krukenberg's Spindle-Like Corneal Changes in a Patient With Prolonged ICU Admission: A Case Report.

Krukenberg's spindles are vertical, spindle-shaped pigment deposits on the posterior cornea and are primarily associated with pigment dispersion syndrome (PDS). We present a case of Krukenberg's spindle-like corneal changes in a 39-year-old male patient following prolonged ICU management for thyroid storm complicated by infective endocarditis. The patient's complex ICU course included mechanical ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and multiple medications. Ophthalmological examination revealed bilateral, brownish, linear changes in the central corneal stro

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… Oral October 20 | November 6 | Sucrose and povidone-iodine | Topical October 20 | November 6 | Betamethasone valerate and gentamicin sulfate | Topical October 20 | November 6 | Hydrocortisone butyrate | Topical July 31 | July 31 | Ceftriaxone sodium hydrate | Intravenous injection July 31 | July 31 | Cefepime … Intravenous injection August 14 | August 20 | Dexmedetomidine hydrochloride | Intravenous injection July 31 | August 24 | Thiamazole | Intravenous injection August 18 | August 20 | Antithrombin gamma | Intravenous injection August 19 | August 19 | Menatetrenone | Intravenous injection August 19 | August 24 | Cefepime …

Acquired Methemoglobinemia Associated with Topical Lidocaine Administration: A Case Report.

A 55-year-old male was admitted to the hospital with pneumonia. During an intubation procedure, the patient received an application of endobronchial lidocaine (4% gel). Within 2 h of intubation, the patient developed worsening hypoxia, and investigation of arterial blood gasses revealed a pH of 7.21, carbon dioxide partial pressure (PaCO2) of 3.3 kPa, oxygen partial pressure (PaO2) of 55.1 kPa, and measured oxygen saturation of 49%. Co-oximetry of this sample returned a methemoglobin level of 53%. Intravenous methylthioninium chloride (1% solution at 1 mg/kg) was delivered, and subsequent arte

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… He was admitted to the hospital and treated with cefepime and azithromycin for presumed pneumonia; further home medications continued during admission included acyclovir, allopurinol, fluconazole and pantoprazole. …