Didier Daneau

Causes of death in patients with cancer.

Abstract The causes of death were analysed in 157 patients who died at the Institut Jules Bordet and a complete anatomic examination was performed on each patient. The clinical and bacteriological data available were taken into consideration, as well as the findings at autopsy, but only overwhelming terminal events were considered. Infection caused by gram-negative microorganisms was the most frequent cause of death in this series and accounted alone for 31·8% of the deaths. Severe haemorrhage was a significant cause of mortality in patients with acute leukaemia but ranked far behind infection. Neoplastic extension to vital organs was a significant cause of death in patients with cancer of the breast and cancer of the lung. Although 90% of the patients in this series had very extensive tumoral spread beyond any possibility of cure by todays antineoplastic therapy, it is believed that supportive care, aimed at the prevention and treatment of infection in such patients might improve their chance for longer survival.

Pneumocystis carinii pneumonia in patients with cancer. An increasing incidence

Background. The incidence of Pneumocystis carinii pneumonia (PCP) is increasing in patients with cancer. Possible nosocomial transmission from patients with acquired immune deficiency syndrome to those with cancer has been advocated.

Therapy with carbenicillin and gentamicin for patients with cancer and severe infections caused by gram-negative rods

Gentamicin, carbenicillin, and the combination of gentamicin and carbenicillin were used at random to treat severe bacteriologically proven infections caused by gram‐negative bacilli. In 68 patients with disseminated cancer, favorable results were observed in 13 out of 23 (57%), 11 out of 22 (50%), and 19 out of 23 (83%) of the patients, respectively. These results correlated well with the higher antibacterial activity found in sera of patients who received the combination of gentamicin and carbenicillin as compared to sera of patients treated with carbenicillin or gentamicin alone. Gentamicin was used in this series at doses ranging from 6 to 8.5 mg/kg/day without the development of serious ototoxicity, or renal toxicity.

Carbenicillin and Hypokalemia

Excerpt To the editor: Brunner and Frick (1) drew attention to the development of hypokalemia and metabolic alkalosis with high-dose sodium benzylpenicillin therapy; and electrolyte disturbances ha...

Comparative Clinical Study of Tobramycin and Gentamicin

Gentamicin and tobramycin have been compared in vitro and as single-drug therapy in patients with a serious infection caused by gram-negative rods. In vitro, a slight advantage of tobramycin over gentamicin has been found against Pseudomonas aeruginosa. Cross-resistance between gentamicin and tobramycin has been observed for gentamicin-resistant strains of P. aeruginosa and Providence but was not always present. The clinical effectiveness of gentamicin and tobramycin was similar: 14 (45.1%) out of the 31 patients in each series responded favorably. The clinical results were much better in urinary tract infections (66% of favorable responses) than in wound infections, pulmonary infections, septicemia, and meningitis (26% of favorable responses). The frequency of adverse reactions encountered in the present series was similar for both drugs.

Comparison of Sisomicin and Gentamicin in Bacteriuric Patients with Underlying Diseases of the Urinary Tract

Sisomicin and gentamicin (2 mg/kg) were administered in a random fashion to patients with bacteriuria superimposed on abnormalities of the urinary tract. Cure was achieved in a similar number of patients in both groups, but superinfection and reinfection with resistant microorganisms was more frequent in patients receiving gentamicin. Untoward side effects were not frequent in this series, especially if the serious underlying urological disease of most patients is taken into consideration. The susceptibility of the causative pathogens to the antibiotic administered and the severity of the underlying disease were the most important factors in the outcome.

Antipseudomonal drugs: Comparative study of gentamicin, sisomicin and tobramycin in vitro and in human volunteers

Abstract Gentamicin, sisomicin and tobramycin were compared in vitro against a variety of micro-organisms isolated from patients who have been admitted to a cancer hospital. No major differences of activity between these antibiotics have been observed, however, sisomicin appeared the most active drug on E. coli , Klebsiella, Proteus strains and Staphylococcus aureus whereas tobramycin was the most active compound on Pseudomonas aeruginosa . Sera of volunteers, treated with these drugs in a cross-over fashion, did not exhibit significantly different activity against the strains tested, although gentamicin appeared more active on E. coli and tobramycin was more effective on Pseudomonas aeruginosa . Cross resistance between gentamicin, sisomicin and tobramycin was frequently found, although not constantly. The combinations of gentamicin, sisomicin and tobramycin with carbenicillin were found frequently synergistic in vitro against Pseudomonas aeruginosa strains. Under these conditions relatively low concentrations of the antibiotics tested were effective in inhibiting most strains tested in this study, even when the microorganism had been found resistant to one of several aminoglycoside drugs used alone. The present study leads to the conclusion that combinations of gentamicin, sisomicin and tobramycin with carbenicillin or related antibiotics, should be evaluated in the treatment of clinical infections, especially those caused by Pseudomonas aeruginosa .

Sisomicin: Bacteriological and Clinical Evaluation

A preliminary study was conducted with sisomicin, a new aminoglycoside antibiotic. The drug was administered to 40 patients in doses varying from 1.5 to 3.75 mg/kg/day. Sisomicin proved to be an effective therapy in urinary tract infections and to a lesser extent in wound infections caused by gram-negative rods; favorable results have been observed in 91.6% and in 66.6% of the patients presenting these infections. Toxic reactions involving the hearing function, renal function, and general tolerance were infrequent: they occurred in less than 5% of the patients in this series. (However in approximately 22% of the patients, there was a transient appearance of granular casts in the urine.

Incidence and Significance of Clostridium-difficile in Hospitalized Cancer-patients

The aim of the study was to assess the incidence and clinical significance ofClostridium difficile in patients in our cancer center. Over a period of seven consecutive months, 557 stools samples obtained from 156 hospitalized cancer patients (37 leukemic patients receiving oral antimicrobial prophylaxis and 119 patients from whom a stool sample was sent to the laboratory) were analyzed for the presence ofClostridium difficile. Clostridium difficile and/or its toxin was recovered from 13 (35 %) of the 37 patients receiving oral antimicrobial prophylaxis, and from 15 (12 %) of the other 119 patients (p<0.05). Isolation ofClostridium difficile was associated with diarrhoea in 13 (46 %) of 28 patients but specific treatment was initiated only in 7 (25 %) of the 28 patients in whomClostridium difficile was isolated. The wide distribution of the serotypes identified in our patients does not suggest an epidemic situation in our hospital.

Bacteriological Evaluation of Minocycline

Inhibitory activity of minocycline was determined using freshly-isolated microorganisms responsible for clinical infections. The activity of minocycline was compared to that of doxycycline and tetracycline. A concentration of 3μg/ml of minocycline, well within the levels obtainable in body fluids after administration of usual doses, was inhibitory against 97% of the strains of staphylococci. This concentration was effective on more than 90% of E. coli, Proteus mirabilis, Klebsiella-Enterobacter and Pseudomonas aeruginosa, provided that the pH of the medium had been adjusted to the pH 5 level. Increase of the size of the inoculum decreased the effectiveness of minocycline, doxycycline, and tetracycline in similar proportions. The critical diameter of the zone size for distinguishing between strains sensitive or resistant to minocycline was determined as a 16-mm diameter. Since minocycline is protein bound and its effect is pH dependant, the clinical interpretation of this in vitro data must be done with caution.