Improved prognosis for granulocytopenic patients with gram-negative bacteremia

The American Journal of Medicine
L J LoveP H Wiernik

Abstract

The grave prognosis associated with gram-negative bacteremia occurring in granulocytopenic patients with cancer suggests that granulocyte transfusions are frequently indicated. We have evaluated 67 episodes of gram-negative bacteremia, studied in four consecutive antibiotic trials, in order to correlate prognostic determinants of recovery. These patients had a median absolute granulocyte count of 100/microliter at the time of bacteremia. Empiric antibiotic regimens were begun at the first evidence of suspected infection. Granulocyte transfusions were employed only as clinically indicated by inadequate patient response to antibiotic therapy. Among the 29 patients who had an increase in their granulocyte count of greater than or equal to 100/microliter over the subsequent 14 days, 27 (93 per cent) recovered whereas among 38 patients who had no appreciable increase in their granulocyte count, 21 (55 per cent) improved (p = 0.006). In this latter group of patients with no granulocyte recovery, the susceptibility of the pathogen(s) to the initial empiric antibiotic regimen was of major importance. None of four patients responded when the pathogen was resistant to both antibiotics initially utilized, six of 14 (44 per cent) patients ...Continue Reading

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Related Concepts

Agranulocytosis
Bacteriocidal Agents
Antibiotic Resistance, Microbial
Polychemotherapy
Achromobacteriaceae
Granulocyte
Lymphapheresis
Differential White Blood Cell Count Procedure
Malignant Neoplasms
Pyemia

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