Naciye Demirel

Bloodstream infections in patients with hematological malignancies: which is more fatal – cancer or resistant pathogens?

Background The primary objective of this study was to report the incidence of bloodstream infections (BSIs) and clinically or microbiologically proven bacterial or fungal BSIs during neutropenic episodes in patients with hematological malignancies. Methods In this retrospective observational study, all patients in the hematology department older than 14 years who developed febrile neutropenia during chemotherapy for hematological cancers were evaluated. Patients were included if they had experienced at least one neutropenic episode between November 2010 and November 2012 due to chemotherapy in the hematology ward. Results During 282 febrile episodes in 126 patients, 66 (23%) episodes of bacteremia and 24 (8%) episodes of fungemia were recorded in 48 (38%) and 18 (14%) patients, respectively. Gram-negative bacteria caused 74% (n=49) of all bacteremic episodes. Carbapenem-resistant Gram-negative bacteria (n=6) caused 12% and 9% of Gram-negative bacteremia episodes and all bacteremia episodes, respectively. Carbapenem-resistant Gram-negative bacteria included Acinetobacter baumannii (n=4), Pseudomonas aeruginosa (n=1), and Serratia marcescens (n=1). Culture-proven invasive fungal infection occurred in 24 episodes in 18 cases during the study period, with 15 episodes in ten cases occurring in the first study year and nine episodes in eight cases in the second study year. In 13 of 18 cases (72%) with bloodstream yeast infections, previous azole exposure was recorded. Candida parapsilosis, C. glabrata, and C. albicans isolates were resistant to voriconazole and fluconazole. Conclusion BSIs that occur during febrile neutropenic episodes in hematology patients due to Gram-negative bacteria should be treated initially with non-carbapenem-based antipseudomonal therapy taking into consideration antimicrobial stewardship. Non-azole antifungal drugs, including caspofungin and liposomal amphotericin B, should be preferred as empirical antifungal therapy in the events of possible or probable invasive fungal infections with an absence of pulmonary findings due to increase azole resistance.

First line treatment of chronic phase chronic myeloid leukaemia patients with the generic formulations of imatinib mesylate

in the prevalence of growth, endocrine and vitamin D abnormalities among the various thalassaemia syndromes in North America. British Journal of Haematology, 146, 546–556. Vogiatzi, M.G., Macklin, E.A., Fung, E.B., Cheung, A.M., Vichinsky, E., Olivieri, N., Kirby, M., Kwiatkowski, J.L., Cunningham, M., Holm, I.A., Lane, J., Schneider, R., Fleisher, M., Grady, R.W., Peterson, C.C., Giardina, P.J. & Thalassemia Clinical Research Network (2009b) Bone disease in thalassemia: a frequent and still unresolved problem. Journal of Bone and Mineral Research, 24, 543–557.

The outcome of non-carbapenem-based empirical antibacterial therapy and VRE colonisation in patients with hematological malignancies.

BACKGROUND Febrile neutropenia (FN) is generally a complication of cancer chemotherapy. OBJECTIVES We retrospectively evaluated the febrile neutropenia episodes and their outcomes with respect to modification rates of non-carbapenem-based empirical antibacterial therapy and vancomycin-resistant enterococcus (VRE) colonisation that caused to VRE bacteremia in patients with hematological malignancies. METHODS All consecutive patients, who were older than 14 years of age and developed febrile neutropenia episodes due to hematological malignancies from September 2010 to November 2011 at the hematology department were included into the study. RESULTS In total, 86 consecutive neutropenic patients and their 151 febrile episodes were evaluated. The mean MASCC prognostic index score was 18,72 ± 9,43. Among 86 patients, 28 patients experienced a total of 30 bacteremia episodes of bacterial origin. Modification rates of both, empirical monotherapy and combination therapies, were found similar, statistically (P = 0,840). CONCLUSIONS Our results suggest that initiating of non-carbapenem based therapy does not provide high response rates in the treatment of febrile neutropenia attacks. Furthermore, non-carbapenem-based empirical therapy provides benefit in regard to cost-effectiveness and antimicrobial stewardship when local antibiotic resistance patterns of gram-negative bacteria are considered. Patients who are colonized with VRE are more likely to develop bacteremia with VRE strains as a result of invasive procedures and severe damage of mucosal barriers observed in this group of patients.

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage

Background Patients with hematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Primary or secondary antifungal prophylaxis is recommended for patients with hematological malignancies to reduce the risk of invasive fungal infection (IFI). This study retrospectively evaluated the efficacy and potential harm of administration of primary and secondary antifungal prophylaxis to patients with hematological malignancies at one hospital. Methods All patients with hematological malignancies older than 14 years of age who had experienced at least one FN attack during chemotherapy while being treated at one hospital between November 2010 and November 2012 were retrospectively evaluated. Results A total of 282 FN episodes in 126 consecutive patients were examined during a 2-year study period. The mean patient age was 51.73±14.4 years (range: 17–82 years), and 66 patients were male. Primary prophylaxis with posaconazole was administered to 13 patients and systemic antifungal treatment under induction or consolidation chemotherapy to seven patients. Of 26 patients who received secondary antifungal prophylaxis with either oral voriconazole (n=17) or posaconazole (n=6) during 46 FN episodes, systemic antifungal therapy was administered in 16 of 38 episodes and three of eight episodes, respectively. Secondary antifungal prophylaxis with caspofungin was found effective in treating six FN episodes in three patients who had experienced at least two persistent candidemia attacks. The mortality rates associated with IFI were 9% in the first year, 2% in the second year, and 6% overall. The mortality rates associated with candidemia were 33% in the first year, 22% in the second year, and 27% overall. Conclusion Primary antifungal prophylaxis should be administered to selected patients on the basis of consideration of efficacy, cost, and potential harm. Use of secondary prophylaxis may reduce systemic antifungal use and IFI frequency but may increase risk of colonization and infection with azole-resistant fungal strains.

Vancomycin-resistant enterococci colonization in patients with hematological malignancies: screening and its cost-effectiveness

BACKGROUND AND OBJECTIVE We evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related bacteremia in patients with hematological malignancies in terms of routine screening culture and its cost-effectiveness. MATERIALS AND METHODS All patients of the hematology department who were older than 14 years of age and who developed at least one febrile neutropenia episode during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated retrospectively. RESULTS We retrospectively analyzed 282 febrile episodes in 126 neutropenic patients during a two-year study period. The study included 65 cases in the first study-year and 78 cases in the second study-year. The numbers of colonization days and colonized patient were748 days of colonization in 29 patients (44%) in the first study-year and 547 colonization days in 21 patients (26%) in the second study-year, respectively. Routine screening culture for VRE cost

Outcomes of Chronic Myeloid Leukemia Patients With Early Molecular Response at 3 and 6 Months: A Comparative Analysis of Generic Imatinib and Glivec

4516,4 (427 cultures) in the first study-year,

Novel Antifungal Drugs Against Fungal Pathogens: Do They Provide Promising Results for Treatment?

5082,7 (504 cultures) in the second study-year depending on the number of patients and their length of stay. CONCLUSION In line with our study results, routine screening of hematological patients for VRE colonization is not costeffective. Routine surveillance culture for VRE should be considered with respect to the conditions of health care setting.

Fungal pathogens and primary antifungal prophylaxis in patients with hematological malignancies: one year experience

Micro‐Abstract We retrospectively evaluated 90 patients with chronic myeloid leukemia receiving either upfront original imatinib (OI) or generic imatinib (GI) for the effect of the early molecular response on the long‐term outcome. We demonstrated that achieving an optimal response at 3 and 6 months in patients receiving either first‐line GI or OI was clearly associated with greater response and event‐free survival rates. Background: The molecular response at 3 months of the original imatinib (OI) in patients with chronic myeloid leukemia has prognostic significance; however, this has never been tested for generic imatinib (GI). Patients and Methods: We evaluated the BCR‐ABL1 [international reporting scale (IS)] transcript levels at 3 and 6 months to determine whether an early molecular response (EMR) had a prognostic effect on the outcome among chronic myeloid leukemia patients receiving GI. Ninety patients were divided into 2 groups, according to the imatinib they received, as OI (group A) and GI (group B). Results: Two groups were equally balanced for age, gender, Sokal risk score, and optimal response. The 2 groups did not differ in achieving an EMR at 3 months, and patients with EMR at 3 months had significantly superior complete cytogenetic response and major molecular response rates compared with patients who did not achieve an EMR in both groups. The percentage of an optimal response [BCR‐ABL1 (IS), < 1%] and a warning response [BCR‐ABL1 (IS), 1%‐10%] at 6 months was 93% and 95% for groups A and B, respectively (P = .553). Patients with an optimal response (OR) at both 3 and 6 months had significantly superior event‐free survival rates compared with patients without an OR in groups A and B. Conclusion: The results of the present study have demonstrated most probably for the first time that an OR at 3 and 6 months in patients receiving either first‐line GI and OI is clearly associated with greater response and event‐free survival rates. Prospective randomized trials with larger numbers of patients and longer follow‐up periods are needed to address the effect of EMR in patients receiving GI.