Antibiotic Rotation for Febrile Neutropenic Patients with Hematological Malignancies Clinical Significance of Antibiotic Heterogeneity.docVIP

下载本文档

2
0
约 8页
2017-05-07 发布于上海
举报
版权申诉

Antibiotic Rotation for Febrile Neutropenic Patients with Hematological Malignancies Clinical Significance of Antibiotic Heterogeneity.doc

1、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。。
2、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
4、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
5、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
6、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
7、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

Antibiotic Rotation for Febrile Neutropenic Patients with Hematological Malignancies Clinical Significance of Antibiotic Heterogeneity

AntibioticRotationforFebrileNeutropenicPatientswith HematologicalMalignancies:ClinicalSignificanceof AntibioticHeterogeneity YongChong1*,ShinjiShimoda1,HirokoYakushiji2,YoshikiyoIto3,ToshihiroMiyamoto1, TomohikoKamimura3,NobuyukiShimono4,KoichiAkashi1 1DepartmentofMedicineandBiosystemicSciences,KyushuUniversityGraduateSchoolofMedicine,Fukuoka,Japan,2DepartmentofClinicalLaboratory,Hara-Sanshin Hospital,Fukuoka,Japan,3DepartmentofBloodandMarrowTransplantation,Hara-SanshinHospital,Fukuoka,Japan,4CenterfortheStudyofGlobalInfection,Kyushu UniversityHospital,Fukuoka,Japan Abstract Background: Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum b-lactamase (ESBL)-producers, was frequently observed in these patients. Therefore,weinstitutedarotationofprimaryantibioticsforfebrileneutropenicpatientsinanattempttocontrolantibiotic resistance. Methods:ThisprospectivetrialwasperformedfromAugust2008throughMarch2011atourunit.Afterapre-intervention period,inwhichcefepimewasusedastheinitialagentforfebrileneutropenia,4primaryantibiotics,namely,piperacillin- tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillancecultureswereconductedforfebrileepisodes,inordertoassesstheetiology,theresistancepattern(particularly tocefepime),andtheprognosis. Results:Inthistrial,219patientswereregistered.A65.9%reductionintheuseofcefepimeoccurredaftertheantibiotic rotation.Inthesurveillancestoolcultures,thedetectionrateofcefepime-resistantgram-negativeisolates,ofwhichESBL- producerswerepredominant,declinedsignificantlyaftertheintervention(8.5vs0.9episodesper1000patientdaysbefore andafterinterventionrespectively,P,0.01).Interestingly,ESBL-relatedbacteremiawasnotdetectedaftertheinitiationof the trial (1.7 vs 0.0 episodes per 1000 patien