23 results on '"Krcmery V Jr"'
Search Results
2. Nosocomial Candida krusei fungemia in cancer patients: report of 10 cases and review.
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Krcmery V Jr, Spanik S, Kunova A, Trupl J, Grausova S, Krupova I, Mateicka F, Pichnova E, Grey E, and Sabo A
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- Adult, Aged, Amphotericin B, Antifungal Agents therapeutic use, Candidiasis mortality, Candidiasis therapy, Cross Infection therapy, Female, Fluconazole, Fungemia mortality, Fungemia therapy, Humans, Incidence, Male, Middle Aged, Neoplasms microbiology, Risk Assessment, Treatment Outcome, Candida pathogenicity, Candidiasis etiology, Cross Infection etiology, Fungemia etiology, Neoplasms complications
- Abstract
The risk factors, therapy and outcome of ten cases of fungemia due to Candida krusei, appearing during the last 10 years in a single national cancer institution, are analyzed. Univariate analyses did not find any specific risk factors in comparison to 51 Candida albicans fungemias appearing at the same institution and with a similar antibiotic policy. Association with prior fluconazole prophylaxis was not confirmed because only one case appeared in a patient previously treated with fluconazole. However, attributable and crude mortality due to C. krusei fungemias was higher than for C. albicans fungemia. The authors review 172 C. krusei fungemias published within the last 10 years to compare with the incidence, therapy and outcome of C. krusei fungemia from our cancer institute.
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- 1999
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3. Hematogenous trichosporonosis in cancer patients: report of 12 cases including 5 during prophylaxis with itraconazol.
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Krcmery V Jr, Mateicka F, Kunová A, Spánik S, Gyarfás J, Sycová Z, and Trupl J
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- Administration, Oral, Adult, Aged, Aged, 80 and over, Aminoglycosides, Amphotericin B administration & dosage, Amphotericin B therapeutic use, Anti-Bacterial Agents therapeutic use, Antifungal Agents administration & dosage, Candidiasis etiology, Catheterization, Central Venous adverse effects, Catheterization, Central Venous instrumentation, Catheterization, Peripheral adverse effects, Catheterization, Peripheral instrumentation, Cause of Death, Cephalosporins therapeutic use, Chemoprevention, Female, Fungemia prevention & control, Humans, Itraconazole administration & dosage, Male, Middle Aged, Mycoses prevention & control, Neoplasms drug therapy, Neutropenia complications, Opportunistic Infections prevention & control, Risk Factors, Antifungal Agents therapeutic use, Fungemia microbiology, Itraconazole therapeutic use, Mycoses etiology, Neoplasms complications, Opportunistic Infections etiology, Trichosporon classification, Trichosporon drug effects
- Abstract
Twelve cases of Trichosporon spp. fungemias occurring in a national cancer institution within 10 years are described. The trend of hematogenous trichosporonosis within the last 10 years is increasing. While no cases occurred in 1988-1991, after 1991, Trichosporon spp. was the most common species among non-Candida spp. fungemias in 1993-1997. The 12 cases of fungemia included 5 that started while the patients were receiving prophylaxis with oral itraconazole, and 2 appeared despite empiric therapy with amphotericin B. Five of the 12 fungemias were catheter associated. Risk factors for fungemia were: central venous catheter, broad-spectrum antibiotics (third-generation cephalosporins plus aminoglycoside); all but 1 had neutropenia and were receiving antineoplastic chemotherapy. All but 2 of the patients died of systemic fungal infection (83.3% mortality). Amphotericin B was administered to all but 1 patient, who was not treated because he died the day after his culture was found to be positive for T. beigelii, before antifungals were administered. All cases infected with T. pullulans were catheter related, and all these patients died. One of the remaining 9 fungemias was caused by T. capitatum (Blastoschizomyces capitatus), and 8 by T. beigelii. Only 2 patients were cured, 1 with a combination therapy with amphotericin B plus fluconazole, and 1 with amphotericin B monotherapy. Several risk factors (neutropenia, acute leukemia, prior therapy or prophylaxis with antifungals and catheter as source of fungemia, breakthrough fungemia) were significantly associated with Trichosporon spp. fungemia, in comparison to 63 C. albicans candidemia occurring in the same period at the same institution. Attributable mortality of hematogenous trichosporonosis was also significantly higher (83.3% vs. 15.8%, P<0.001) than that of hematogenous candidiasis.
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- 1999
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4. Aetiology, cost of antimicrobial therapy and outcome in neutropenic patients who developed bacteraemia during antimicrobial prophylaxis: a case-control study.
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Krupova Y, Novotny J, Sabo A, Mateicka F, and Krcmery V Jr
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- Amikacin therapeutic use, Amphotericin B therapeutic use, Bacteremia economics, Bacteremia etiology, Case-Control Studies, Catheters, Indwelling, Ceftazidime therapeutic use, Enterococcus, Female, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections economics, Gram-Negative Bacterial Infections etiology, Gram-Positive Bacterial Infections drug therapy, Gram-Positive Bacterial Infections economics, Gram-Positive Bacterial Infections etiology, Humans, Male, Retrospective Studies, Streptococcal Infections drug therapy, Streptococcal Infections economics, Streptococcal Infections etiology, Treatment Outcome, Vancomycin therapeutic use, Xanthomonas, Antibiotic Prophylaxis, Bacteremia drug therapy, Bacterial Infections prevention & control, Drug Therapy, Combination therapeutic use, Fluconazole therapeutic use, Neoplasms complications, Neutropenia complications, Ofloxacin therapeutic use
- Abstract
Sixty four episodes of bacteraemia that appeared during antimicrobial prophylaxis with an oral quinolone plus an azole in neutropenic cancer patients were compared with 128 cases of bacteraemia in a cohort of controls matched for age, sex, underlying disease, neutropenia and vascular catheter in situ to assess differences in aetiology, cost of therapy and outcome. Patients who received prophylaxis had breakthrough bacteraemias of a different aetiology compared with the control group: they had significantly fewer multiply-resistant strains (21.9 vs. 51.5, P < 0.04) and a longer afebrile neutropenic period (9.55 days vs. 4.1, P < 0.001). Patients who received prophylaxis also had bacteraemias that were significantly more frequently caused by viridans streptococci (9.4%, vs. 1.7%, P < 0.01), enterococci (15.6% vs. 7.2%, P < 0.05) and Stenotrophomonas maltophilia (17.2% vs. 3.4%, P < 0.01). The cost of antimicrobial therapy per case (37401 SKK (1091 USD) vs. 31808 SKK (899 USD), P < 0.05) was also significantly higher in cases than controls; however, the number of administered antibiotics (4.18 vs. 3.21 per case, P = NS) was similar in both groups. There were no differences in outcome between both groups. However patients who received prophylaxis had significantly longer periods of afebrile neutropenia (9.55 days vs. 4.1, P < 0.001) and bacteraemia developed later than in controls. Also, the incidence of polymicrobial bacteraemia caused by multiresistant strains was lower among cases (21.9 vs. 51.5, P < 0.04).
- Published
- 1998
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5. Inappropriate antibiotic therapy in febrile cancer patients with bacteremia.
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Spanik S, West D, Pichna P, Novotny J, Dacok J, Mraz M, Chmelik B, Krupova I, and Krcmery V Jr
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- Bacteremia complications, Cancer Care Facilities statistics & numerical data, Health Services Misuse, Humans, Risk Factors, Slovakia, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Cancer Care Facilities standards, Fever complications, Medication Errors, Neoplasms complications, Treatment Outcome
- Abstract
Objective: The aim of the study was to assess the outcome of inappropriately treated cancer patients with documented bacteremia., Design/setting: 95 cases of inappropriately treated bacteremias in febrile cancer patients in a tertiary-care center were analyzed and compared with a group of appropriately treated bacteremias to assess risk factors for inappropriate therapy and outcome., Results: Among 285 bacteremias, 95 (33.3%) were not treated appropriately, with 42 receiving the wrong antibiotics and 17 having too short a therapeutic course of appropriate antibiotics. In 13, therapy was delayed for more than 48 hours after the onset of fever. Twenty-three patients did not receive antibiotic therapy at all despite bacteremia. A group of 95 inappropriately treated bacteremias was compared to 190 appropriately treated bacteremias occurring in the same period. Microbiological cure after the initial course of therapy was achieved more often (76.8% vs 38.9%, P < .001) in the group of appropriately treated bacteremias in all cases and also in the subgroup of leukemic patients (P < .01). Overall and attributable mortality were significantly lower in patients who were treated appropriately. There was no difference in the number of antibiotics administered in appropriately versus inappropriately treated bacteremias. Cost of therapy between both groups was similar., Conclusions: Inappropriately treated bacteremic cancer patients had outcomes that were significantly worse than patients who were treated appropriately. The reasons for inappropriate therapy were selection of the wrong antimicrobials, too short a duration of therapy, delayed onset of therapy, or absence of antimicrobial therapy.
- Published
- 1998
6. Bacteremia and fungemia in pediatric versus adult cancer patients after chemotherapy: comparison of etiology, risk factors and outcome.
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Krupova I, Kaiserova E, Foltinova A, Kovacicova G, Kiskova M, Krchnakova A, Kunova A, Trupl J, West D, and Krcmery V Jr
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- Adult, Analysis of Variance, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents therapeutic use, Antifungal Agents therapeutic use, Antineoplastic Agents therapeutic use, Bacteremia microbiology, Child, Colistin therapeutic use, Fluconazole therapeutic use, Fungemia microbiology, Gram-Negative Bacterial Infections blood, Gram-Negative Bacterial Infections prevention & control, Gram-Positive Bacterial Infections blood, Gram-Positive Bacterial Infections prevention & control, Humans, Neutropenia chemically induced, Neutropenia complications, Ofloxacin therapeutic use, Penicillin V therapeutic use, Penicillins therapeutic use, Retrospective Studies, Risk Factors, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Antibiotic Prophylaxis methods, Antineoplastic Agents adverse effects, Bacteremia etiology, Bacteremia prevention & control, Fungemia etiology, Fungemia prevention & control, Neoplasms complications, Neoplasms drug therapy
- Abstract
One hundred and eighteen (118) episodes of bacteremia and fungemia in children with cancer were compared to 401 episodes of bacteremia and fungemia in adults with cancer to assess differences in etiology, risk factors and outcome. A retrospective univariate analysis was performed of all episodes of bacteremia in national pediatric and adult cancer institutions appearing in 1990-1996. A total of 519 episodes of bacteremia were assessed and compared. Both cancer centers differed in prophylactic antibiotic policies. About 50% of adults but less than 5% of children received quinolone prophylaxis during neutropenia, even though the empiric antibiotic therapeutic strategy was similar. There were differences in etiology between the groups: staphylococci and Stenotrophomonas maltophilia were more frequently observed in children (P<0.01), Pseudomonas aeruginosa and Acinetobacter spp. in adults (P<0.05). Gram-positive bacteremia was surprisingly more commonly observed in adults (65.7% vs 33.3%, P<0.01). Mixed polymicrobial bacteremia occurred more commonly in adults (31.8% vs 7.6%, P<0.001) than in children. Analysis of risk factors did not observe differences in risk factors except for underlying disease (acute leukemia was more frequently observed in children -48.3% vs adults 33.7%, P<0.05 and prophylaxis: (prior prophylaxis with quinolones was more common in adults (47.5%) than in children (2.5%) P<0.0001). Overall and attributable mortality in pediatric bacteremia was significantly lower than in adults (P<0.03).
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- 1998
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7. Predictors of mortality in bacteremic cancer patients: retrospective analysis of 64 deaths occurring among 262 bacteremic episodes.
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Spanik S, Sufliarsky J, Mardiak J, Sorkovska D, Trupl J, Kunova A, Kukuckova E, Rusnakova V, Demitrovicova A, Pichna P, Krupova I, Kralovicova K, Mateićka F, West D, and Krcmery V Jr
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- Adult, Aged, Antibiotic Prophylaxis, Antineoplastic Agents adverse effects, Bacteria isolation & purification, Female, Humans, Male, Middle Aged, Neoplasms drug therapy, Neutropenia chemically induced, Neutropenia mortality, Retrospective Studies, Risk Factors, Bacteremia mortality, Cause of Death, Neoplasms mortality, Opportunistic Infections mortality
- Abstract
A total of 262 bacteremic episodes were observed in cancer patients in a single cancer institution during the last 7 years, and the recorded outcome was death in 65. The 65 patients who died (24.8% overall mortality) were divided retrospectively into two subgroups: (a) those who died of underlying disease with bacteremia (45 cases, 16.9% crude mortality) and (b) those who died of bacteremia (20 patients, 7.7% attributable mortality). Comparison of several risk factors in subgroups of patients who achieved a cure (197 cases) and of those who died and whose deaths were attributable (20 cases) revealed six risk factors that were associated with attributable mortality: (1) chemotherapy-induced neutropenia (P < 0.03), (2) Acinetobacter/Stenotrophomonas spp. bacteremias (P < 0.001), (3) liver failure (P < 0.001), (4) inappropriate therapy (P < 0.0001), (5) organ complications (P < 0.003) and (6) multiresistant organisms (P < 0.001). Enterococci and Pseudomonas aeruginosa, surprisingly, were found more frequently in those who died of an underlying disease with bacteremia than among patients who were cured (17.6% vs 7.6%, P < 0.05 and 29.1% vs 13.8%, P < 0.02). Those who died of infection had higher numbers of positive blood cultures, with 2.05 per episode, than did those who died of underlying disease with bacteremia (1.82) or those who were cured (1.51). Other risk factors, such as underlying disease, type of chemotherapy, origin of bacteremia, age, and catheters did not predict either overall or attributable mortality within the study group.
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- 1998
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8. Nosocomial breakthrough fungaemia during antifungal prophylaxis or empirical antifungal therapy in 41 cancer patients receiving antineoplastic chemotherapy: analysis of aetiology risk factors and outcome.
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Krcmery V Jr, Oravcova E, Spanik S, Mrazova-Studena M, Trupl J, Kunova A, Stopkova-Grey K, Kukuckova E, Krupova I, Demitrovicova A, and Kralovicova K
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- Amphotericin B administration & dosage, Amphotericin B therapeutic use, Antifungal Agents administration & dosage, Antineoplastic Agents administration & dosage, Cross Infection etiology, Cross Infection microbiology, Drug Resistance, Microbial, Drug Resistance, Multiple, Drug Therapy, Combination, Female, Fluconazole administration & dosage, Fluconazole therapeutic use, Fungemia epidemiology, Fungemia etiology, Humans, Incidence, Itraconazole administration & dosage, Itraconazole therapeutic use, Ketoconazole administration & dosage, Ketoconazole therapeutic use, Male, Mitosporic Fungi drug effects, Neoplasms complications, Neoplasms prevention & control, Pichia drug effects, Retrospective Studies, Risk Factors, Slovakia epidemiology, Treatment Outcome, Antifungal Agents therapeutic use, Antineoplastic Agents therapeutic use, Fungemia prevention & control, Neoplasms drug therapy
- Abstract
Forty-one episodes of breakthrough fungaemia occurring over a 7.5 year period in the National and St Elizabeth's Cancer Institutes in Bratislava, Slovakia, were analysed. Five of them occurred during prophylaxis with fluconazole (one Torulopsis glabrata, one Hansenula anomala, two Candida krusei and one Candida parapsilosis), ten with itraconazole (three Trichosporon pullulans, one Trichosporon beigelii, one Cryptococcus laurentii, three Candida albicans and two T. glabrata), 11 during prophylaxis with ketoconazole (one Candida norvegenesis, one C. parapsilosis, one C. krusei, one Candida tropicalis, five C. albicans, one Candida stellatoidea and one C. laurentii and 15 during empirical therapy with amphotericin B (ten C. albicans, two T. beigelii and three Candida lusitaniae). The most frequent risk factors for breakthrough fungaemia were neutropenia, previous therapy with multiple antibiotics and recent catheter insertion. Comparing these episodes with 38 non-breakthrough fungaemias (appearing at the same institute in the same period) differences in certain risk factors were noted: breakthrough fungaemias were more frequently observed in patients with acute leukaemia (39.0% vs 5.2%, P < 0.001), mucositis (34.2% vs 13.1%, P < 0.05), prophylaxis with quinolones (58.5% vs 15.8%, P < 0.0001) and catheter-associated infections (29.3% vs 2.6%, P < 0.003). In this subgroup overall mortality (36.6% vs 28.8%) or early attributable mortality (22.0% vs 23.6%) were not significantly different.
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- 1998
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9. Do vancomycin serum levels predict failures of vancomycin therapy or nephrotoxicity in cancer patients?
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Kralovicová K, Spanik S, Halko J, Netriova J, Studena-Mrazova M, Novotny J, Grausova S, Koren P, Krupova I, Demitrovicova A, Kukuckova E, and Krcmery V Jr
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- Aminoglycosides, Amphotericin B adverse effects, Amphotericin B therapeutic use, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents therapeutic use, Bacteremia complications, Case-Control Studies, Drug Resistance, Microbial, Drug Synergism, Drug Therapy, Combination, Humans, Kidney Diseases chemically induced, Neoplasms blood, Neoplasms complications, Neutropenia drug therapy, Risk Factors, Slovakia, Vancomycin adverse effects, Anti-Bacterial Agents blood, Bacteremia drug therapy, Neoplasms metabolism, Vancomycin blood, Vancomycin therapeutic use
- Abstract
The purpose of this study was to determine if patients with high vancomycin (VAN) serum levels experience more toxicity than underdosed patients with lower (VAN) levels, and whether low VAN serum levels cause therapeutic failures in patients with gram-positive bacteremia. In 198 cancer patients trough and peak serum levels of VAN were measured. Acute toxicity (Red Man syndrome) appeared in 3 patients (1.5%). Patients previously or currently treated with other nephrotoxic compounds (134 patients) presented the same incidence of nephrotoxicity as those receiving VAN for the first time in monotherapy (64 patients). VAN did not increase the toxicity when patients were dosed simultaneously or previously with aminoglycosides or amphotericin B. Our second observation, when studying serum levels in our 198 patients was that high VAN trough serum levels (trough > 15 microg/mL) were associated with significantly more nephrotoxicity (33.3% vs. 11.1%, P < 0.03) than low levels in the subgroups of either pretreated patients or unpretreated with other nephrotoxic drugs. None of 198 patients who had trough levels below 15 microg/mL had peak levels exceeding 40 microg/mL. This suggests that only serum monitoring of trough levels may predict nephrotoxicity. A case control study was conducted to compare a group of 22 VAN failures with 22 successfully treated patients matched in underlying disease and neutropenia who were treated in the same period, under the same antibiotic policy, at the same cancer center, for gram-positive bacteremia. Persisting, enterococcal, or mixed enterococcal plus staphylococcal bacteremia were the only statistically significant risk factors which predicted therapy failure in cancer patients. Neither peak nor trough VAN serum levels predicted failure or cure of gram-positive bacteremia in cancer patients.
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- 1997
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10. Eight-year surveillance of non-albicans Candida spp. in an oncology department prior to and after fluconazole had been introduced into antifungal prophylaxis.
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Kunova A, Trupl J, Demitrovicova A, Jesenska Z, Grausova S, Grey E, Pichna P, Kralovicova K, Sorkovska D, Krupova I, Spanik S, Studena M, Koren P, and Krcmery V Jr
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- Anti-Infective Agents pharmacology, Antifungal Agents pharmacology, Candida classification, Candida drug effects, Fungemia microbiology, Humans, Population Surveillance, Slovakia epidemiology, Species Specificity, Candida isolation & purification, Fungemia epidemiology, Neoplasms microbiology
- Abstract
From 1989 until 1996, during the last 8 years, the proportion of Candida (C.) krusei, and other non-albicans Candida spp. isolated from surveillance cultures and from sterile body sites, was analyzed among 13,758 admissions in a National Cancer Institute. During these admissions a total of 9,042 isolates were prospectively collected from surveillance cultures, and 126 from blood cultures. The proportion of C. krusei among all organisms was 12.7% to 16.5% in 1989 through 1991, i.e., before fluconazole was introduced into prophylactic protocols. After the introduction of fluconazole into prophylaxis in acute leukemia in 1992 the incidence of C. krusei was 7.9% to 8.6% during 1994 to 1996. After 5 years of using this drug for prophylaxis, the incidence of C. krusei was lower than before this drug was introduced in our institute. Among yeasts, the most frequently isolated pathogen was still Candida albicans (72.2% of all isolated fungal organisms). Among molds, Aspergillus spp. was the most frequently isolated agent. Analyzing the etiology of proven fungal infections (fungemias) confirmed by positive blood cultures, C. albicans was the most common causative organism in 53.8% of cases. The incidence of fungemia due to Torulopsis (C.) glabrata and C. krusei before and after fluconazole introduction did not change. Of 126 organisms isolated from blood cultures, there was no increase in T. (C.) glabrata or C. krusei after introduction of fluconazole for prophylaxis and therapy, and the quoted 6.4% of fungemic episodes remained stable with an incidence of 1 fungemia/year since 1991. The proportion of C. krusei and C. glabrata among Candida spp. was decreasing in our center between 1989 and 1996. Also, the proportion of non-albicans Candida spp. among isolates decreased from 25.7% in 1990 to 11.9% in 1996.
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- 1997
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11. Fungaemia due to Fusarium spp. in cancer patients.
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Krcmery V Jr, Jesenska Z, Spanik S, Gyarfas J, Nogova J, Botek R, Mardiak J, Sufliarsky J, Sisolakova J, Vanickova M, Kunova A, Studena M, and Trupl J
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- Adult, Aged, Fatal Outcome, Female, Humans, Infection Control, Male, Middle Aged, Neutropenia complications, Risk Factors, Cross Infection etiology, Fungemia etiology, Fusarium classification, Neoplasms complications
- Abstract
Five cases of fungaemia due to Fusarium spp. in cancer patients are described. Two were breakthrough cases, despite ongoing therapy with amphotericin B. Three were caused by Fusarium solani, one by F. oxysporum and one by F. dimerum. Four patients died, three of them despite therapy with amphotericin B for between 5-37 days. We describe only the second reported case of F. dimerum fungaemia. Since 1972, 93 cases of systemic infection with Fusarium spp. have been described: 43 had positive blood cultures and the overall mortality was 72%.
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- 1997
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12. Analysis of 553 episodes of monomicrobial bacteraemia in cancer patients: any association between risk factors and outcome to particular pathogen?
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Spanik S, Kukuckova E, Pichna P, Grausova S, Krupova I, Rusnakova V, Kralovicova K, Krchnakova A, Mrazova M, Lacka J, Koren P, Stopkova K, Nogova J, Demitrovicova A, Helpianska L, and Krcmery V Jr
- Subjects
- Chi-Square Distribution, Fungemia microbiology, Humans, Logistic Models, Multivariate Analysis, Neoplasms drug therapy, Prognosis, Risk Factors, Shock, Septic microbiology, Slovakia, Bacteremia microbiology, Neoplasms complications
- Abstract
Relationships between aetiology, various risk factors (such as neutropenia, catheter insertion, endoscopy, therapy with corticosteroids, therapeutic use of antimicrobials, antibiotic prophylaxis, source of infection), symptomatology and outcome were studied in 553 monomicrobial bacteraemic episodes in cancer patients observed within 7 years at the National Cancer Institute of the Slovak Republic. The ratio of gram-positive to gram-negative bacteraemia was 1:1 (43.5% vs 43.8%), and yeasts caused 7.2% of monomicrobial episodes. The highest mortality was associated with Pseudomonas aeruginosa (19.2%), non-albicans Candida yeasts (25%) and Bacteroides fragilis (22.6%). Independent risk factors for particular pathogens were investigated by a computerized logistic regression model. The only independent risk factor for staphylococcal and enterococcal bacteraemia was vascular catheter insertion (OR = 1.95 and 2.05, CI = 95%, P = 0.035 and 0.044, respectively). However, there were no independent specific risk significant factors for viridans streptococcal bacteraemia and bacteraemia due to Enterobacteriaceae or Ps. aeruginosa. Neutropenia was found to be an independent predictor for development of Acinetobacter spp. bacteraemia (OR = 3.84, CI = 95%, P = 0.044). Prior therapy with third-generation cephalosporines was a predictive, independent risk factor for the development of fungaemia (OR = 1.99, CI = 95%, P = 0.028) but not of enterococcal bacteraemia. We also did not observe any association between prior therapy with imipenem and Stenotrophomonas maltophilia bacteraemias. Multivariate analysis confirmed that fungaemia may be independently associated with higher mortality than bacteraemia caused by Enterobacteriaceae and staphylococci. However, the mortality of fungaemia was statistically no different from that of Ps. aeruginosa, Stenotrophomonas spp. and viridans streptococci bacteraemias.
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- 1997
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13. Postoperative bacteremia in cancer patients with solid tumors undergoing surgery: risk factors, etiology and outcome in 276 patients.
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Spanik S, Stopkova K, Grausova S, Koren P, Sepesi J, and Krcmery V Jr
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- Antineoplastic Agents adverse effects, Humans, Immunocompromised Host, Neoplasms drug therapy, Risk Factors, Bacteremia etiology, Neoplasms surgery, Postoperative Complications etiology
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- 1997
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14. Bacteremia in cancer patients with solid tumors undergoing chemotherapy versus surgery: risk factors, etiology and outcome in 276 patients.
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Krcmery V Jr, Spanik S, Stopkova K, Grausova S, Mardiak J, Koren P, Sepesi J, Pechan J, Demitrovicová A, Kralovicová K, and Novotny J
- Subjects
- Bacteremia epidemiology, Female, Humans, Incidence, Male, Middle Aged, Neoplasms complications, Neoplasms surgery, Retrospective Studies, Risk Factors, Treatment Outcome, Antineoplastic Agents therapeutic use, Bacteremia etiology, Neoplasms therapy
- Abstract
Etiology, risk factors, outcome and complications of bacteremia in 276 patients with solid tumors were analyzed. A group of 78 patients with solid tumors and surgical therapy only was compared with 172 patients with solid tumors who were treated with chemotherapy only. The most frequently observed risk factors of bacteremia in patients after surgery was urinary catheter insertion, wound as source of bacteremia, age > 60, staphylococci, enterococci and Enterobacteriaceae as etiologic agents. In comparison, viridans streptococci and Pseudomonas aeruginosa as etiologic agents as well as vascular catheters were significantly more frequently found in those treated with chemotherapy only. Patients with bacteremia after surgery only had a lower incidence of septic shock (6.4 vs. 16.9%, P < 0.03) and also lower mortality (5.6 vs. 14.9%, P < 0.04) attributable to shock than patients being treated for solid tumors with chemotherapy only.
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- 1997
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15. Fungemia in cancer patients undergoing chemotherapy versus surgery: risk factors, etiology and outcome.
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Kralovicova K, Spanik S, Oravcova E, Mrazova M, Morova E, Gulikova V, Kukuckova E, Koren P, Pichna P, Nogova J, Kunova A, Trupl J, and Krcmery V Jr
- Subjects
- Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis, Antifungal Agents therapeutic use, Candidiasis mortality, Case-Control Studies, Catheters, Indwelling microbiology, Fungemia mortality, Fungi isolation & purification, Humans, Multivariate Analysis, Neoplasms drug therapy, Neoplasms surgery, Neutropenia complications, Risk Factors, Yeasts isolation & purification, Antineoplastic Agents therapeutic use, Candidiasis etiology, Fungemia etiology, Neoplasms complications
- Abstract
26 patients with fungemia and cancer treated with chemotherapy (group A) were compared to 25 patients with fungemia and cancer treated with surgery (group B), to assess differences in etiology, risk factors and outcome. Candida albicans was responsible for 42% of fungemias in group A, and for 92% of fungemias in group B (p < 0.005). Breakthrough fungemia occurring during antifungal prophylaxis appeared in 46.6% of group A vs 12% of group B (p < 0.02). There was significant difference in outcome between the groups: 20% of patients after surgery vs 7.7% of those after chemotherapy died from fungemia (p < 0.04). Most common risk factors recorded in both groups were catheter insertion and previous therapy with broad spectrum antibiotics.
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- 1997
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16. Viridans streptococcal bacteraemia due to penicillin-resistant and penicillin-sensitive streptococci: analysis of risk factors and outcome in 60 patients from a single cancer centre before and after penicillin is used for prophylaxis.
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Spanik S, Trupl J, Kunova A, Botek R, Sorkovska D, Grey E, Studena M, Lacka J, Oravcova E, Krchnakova A, Rusnakova V, Svec J, Krupova I, Grausova S, Stopkova K, Koren P, and Krcmery V Jr
- Subjects
- Acute Disease, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents therapeutic use, Bacteremia complications, Bacteremia epidemiology, Drug Therapy, Combination therapeutic use, Humans, Incidence, Leukemia complications, Ofloxacin, Penicillin V therapeutic use, Retrospective Studies, Risk Factors, Streptococcal Infections complications, Streptococcal Infections epidemiology, Treatment Outcome, Vancomycin therapeutic use, Antibiotic Prophylaxis, Bacteremia microbiology, Neoplasms complications, Penicillin Resistance, Penicillins therapeutic use, Streptococcal Infections microbiology
- Abstract
60 patients with 60 viridans streptococcal bacteraemic episodes (42 due to penicillin-sensitive and 18 due to penicillin-resistant viridans streptococci) were analysed in a population of 12,185 admissions and 1,380 bacteraemic episodes during a 7-year period in a National Cancer Institute. The incidence of viridans streptococci among bacteraemias decreased from 11.5% in 1989 to 2.5% in 1995 after penicillin was introduced for prophylaxis of febrile neutropenia in acute leukaemia in 1993. However, the proportion of penicillin-resistant viridans streptococcal bacteraemias increased from 0 in 1989 and 1990 before any prophylaxis was given, to 12.9-16.7% after quinolones were used for prophylaxis in 1991 and 1992, and to 44.4-81.8% in 1993-1995 after penicillin was added to the quinolones. Mortality rate was higher in the subgroup of penicillin-resistant viridans streptococcal bacteraemias (p < 0.05). Statistically significant risk factors in patients with penicillin-resistant (compared with penicillin-sensitive) viridans streptococcal bacteraemia were: acute leukaemia (p < 0.03), high doses of cytarabine (p < 0.05), mucocutaneous lesions (p < 0.004), breakthrough bacteraemia during prophylaxis with ofloxacine plus penicillin (p < 0.001). Multiple logistic regression analysis showed that only acute leukaemia (OR 2.05, CI 0.85-1.85, p < 0.00452) and penicillin-resistance (OR 0.71, CI 0.103-4.887, p < 0.0209) were significant independent predictors of inferior outcome. Breakthrough bacteraemia during empiric therapy with vancomycine occurred in 5 of 116 patients treated with vancomycine, and during therapy with ampicillin plus gentamicin in 6 patients of 18 treated.
- Published
- 1997
- Full Text
- View/download PDF
17. Staphylococcal bacteremia in cancer patients: risk factors and outcome in 134 episodes prior to and after introduction of quinolones into infection prevention in neutropenia.
- Author
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Kukuckova E, Spanik S, Ilavska I, Helpianska L, Oravcova E, Lacka J, Krupova I, Grausova S, Koren P, Bezakova I, Grey E, Balaz M, Studena M, Kunova A, Torfs K, Trupl J, Korec S, Stopkova K, and Krcmery V Jr
- Subjects
- Adult, Anti-Bacterial Agents, Bacteremia epidemiology, Bacteremia etiology, Drug Resistance, Microbial, Drug Therapy, Combination therapeutic use, Female, Fluoroquinolones, Humans, Incidence, Male, Retrospective Studies, Risk Factors, Slovakia epidemiology, Staphylococcal Infections epidemiology, Staphylococcal Infections etiology, Survival Rate, Treatment Outcome, Anti-Infective Agents therapeutic use, Bacteremia prevention & control, Neoplasms complications, Neutropenia complications, Staphylococcal Infections prevention & control
- Abstract
A total of 134 episodes of staphylococcal bacteremia (SBE) appearing among 9987 admissions, and 979 episodes of bacteremia in cancer patients within 5 years, were analyzed for risk factors, clinical course and outcome; 64 were monomicrobial and 70 polymicrobial. The most frequent risk factors were acute leukemia, catheter insertion, long-lasting neutropenia, and prior prophylaxis with quinolones. There was no significant difference between polymicrobial and monomicrobial SBE in risk factors. The two groups differed only in the source of bacteremia (gastrointestinal and respiratory-tract infections were more common in monomicrobial SBE) and etiology-Staphylococcus aureus appeared more frequently in monomicrobial than in polymicrobial bacteremia (20.3% compared to 4.3%, P < 0.05). More complications (14.3%) such as abscesses, endocarditis, etc. appeared in the group of polymicrobial SBE (P < 0.05). No difference was observed in clinical course and outcome between monomicrobial and polymicrobial SBE. The incidence of SBE has increased since 1991, when quinolones were first used in prophylaxis in afebrile neutropenia at our center; however, the infection-associated mortality in monomicrobial SBE was low (4.3%).
- Published
- 1996
- Full Text
- View/download PDF
18. Bacteremia and fungemia occurring during antimicrobial prophylaxis with ofloxacin in cancer patients: risk factors, etiology and outcome.
- Author
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Spanik S, Trupl J, Ilavska I, Helpianska L, Drgona L, Demitrovicova A, Kukuckova E, Studena M, Pichna P, Oravcova E, Rusnakova V, Koren P, Lacka J, and Krcmery V Jr
- Subjects
- Bacteremia epidemiology, Disease Outbreaks, Fungemia epidemiology, Humans, Incidence, Microbial Sensitivity Tests, Opportunistic Infections epidemiology, Retrospective Studies, Risk Factors, Slovakia epidemiology, Treatment Outcome, Bacteremia prevention & control, Fungemia prevention & control, Neoplasms complications, Ofloxacin therapeutic use, Opportunistic Infections prevention & control
- Abstract
The authors analyzed 27 breakthrough bacteremias occurring during ofloxacin prophylaxis in afebrile neutropenia over 7 years in 9989 admissions and 979 bacteremic and fungemic episodes in a National Cancer Center in Bratislava, Slovak Republic. The most frequently isolated organisms in breakthrough bacteremias were gram-positive (71.3%), mainly coagulase-negative staphylococci (41.3%), enterococci (9.2%) and Corynebacteria (9.2%), followed by gram-negative rods-Pseudomonas aeruginosa (13.2%) and Stenotrophomonas maltophilia (9.2%). The outcome of breakthrough bacteremias during ofloxacin prophylaxis was not associated with the underlying disease, neutropenia, catheter insertion or resistance, but only with multiple risk factors. A higher failure rate was observed in those patients having a catheter infected with a resistant organism and during neutropenia. No patients with Hickman catheter were included in the study. Patients with mixed breakthrough bacteremia due to gram-negative and gram-positive organisms had higher failure rates than those with monomicrobial bacteremia. Catheter extraction and rapid institution of intravenous antibiotics in combination should be administered in breakthrough bacteremia.
- Published
- 1996
- Full Text
- View/download PDF
19. Emerging fungal infections in cancer patients.
- Author
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Krcmery V Jr
- Subjects
- Cross Infection epidemiology, Cross Infection therapy, Drug Resistance, Microbial, Humans, Infection Control, Mycoses epidemiology, Mycoses therapy, Risk Factors, Treatment Outcome, Cross Infection etiology, Immunocompromised Host, Mycoses etiology, Neoplasms complications
- Abstract
The increasing number of reports in cancer patients that describe unusual or new fungal pathogens in severe systemic infections may be due, in part, to new treatment regimens but also to increased recognition of clinical disease by physicians and unusual organisms by microbiologists. Identification of these pathogens requires specialized expertise but the diagnosis may often be too late to permit effective therapeutic intervention. An unfortunate limitation of current antifungal agents is their limited efficacy in the heavily immunosuppressed, even when the drugs show good activity in vitro. Infections with Candida spp., and non-Candida yeasts and moulds are often disseminated and are frequently fatal in patients with severe immunosuppression. Therapeutic outcomes could be improved with more precise and rapid diagnostic procedures, standardized treatments for each pathogen and improved therapeutic agents. Liposomal amphotericin B formulations, new azole antifungals, more aggressive surgery and haemopoietic growth factors may improve the poor outcome that currently occurs with many of those infections.
- Published
- 1996
- Full Text
- View/download PDF
20. Imipenen-resistant Ps. aeruginosa bacteraemia in cancer patients: risk factors, clinical features and outcome.
- Author
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Krcmery V Jr, Trup J, Kunova A, Spanik S, Drgona L, Oravcova E, Studena M, Lacka J, Sevcikova L, Koren P, Kukuckova E, Stopkova K, Krupova I, Grausova S, and Svec J
- Subjects
- Adult, Bacteremia etiology, Cancer Care Facilities, Drug Resistance, Microbial, Humans, Incidence, Pseudomonas Infections drug therapy, Pseudomonas Infections mortality, Risk Factors, Shock, Septic epidemiology, Slovakia, Bacteremia epidemiology, Imipenem therapeutic use, Neoplasms complications, Pseudomonas Infections epidemiology, Thienamycins therapeutic use
- Abstract
Ninety-nine patients with 101 bacteraemic episodes due to Pseudomonas aeruginosa (PA) within 6 years were divided into two groups according to their resistance to imipenem; of these 91 episodes were due to imipenem-sensitive (ISPA) and 10 due to imipenem-resistant (IRPA) strains. Risk factors, clinical course and outcome were evaluated and compared in the two groups. Acute leukaemia, long-lasting neutropenia, previous therapy with amikacin, third-generation cephalosporins, imipenem and prophylaxis with quinolones were significantly more frequently associated with IRPA than with ISPA. Imipenem-resistant PA bactereamias were associated with a higher incidence of septic shock (40% vs 19.8%) p. 161 0.02) and death 33.3%) than were ISPA bacteraemias. Since 1992, when first IRPA appeared, the incidence of imipenem-resistance increased tenfold, and in 1994, up to 10% of the PA populations causing bloodstream infections in cancer patients in our centre were imipenem-resistant.
- Published
- 1996
21. Invasive mold infections in cancer patients: 5 years' experience with Aspergillus, Mucor, Fusarium and Acremonium infections.
- Author
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Krcmery V Jr, Kunova E, Jesenska Z, Trupl J, Spanik S, Mardiak J, Studena M, and Kukuckova E
- Subjects
- Acremonium, Adolescent, Adult, Aged, Antifungal Agents therapeutic use, Aspergillosis complications, Aspergillosis drug therapy, Child, Female, Fusarium, Humans, Male, Middle Aged, Mucormycosis complications, Mucormycosis drug therapy, Mycoses drug therapy, Prognosis, Retrospective Studies, Risk Factors, Mycoses complications, Neoplasms complications
- Abstract
Twenty systemic mold infections due to hyphic fungi (molds) arising within the last 5 years in a 60-bed cancer department are analyzed. The most frequent risk factors were plants in ward (75%), prior therapy with broad spectrum antibiotics (70%), catheter insertion (70%), acute leukemia (65%) and neutropenia (60%). Before death, a definitive diagnosis was made in 40%, and a presumptive diagnosis in 60% of patients: post mortem the presumptive antemortem diagnosis was confirmed in all cases (100% of patients). Aspergillosis was the most common invasive fungal disease (55%), followed by mucormycosis (15%), fusariosis (15%), and acremoniosis (10%). Of 20 patients, 8 (40%) were cured or improved after antifungal therapy with amphotericin B, ambisome and/or itraconazole; 8/20 (40%) died of fungal infection and 4/20 (20%) of underlying disease with fungal infection. Even though the diagnosis was made and antifungal therapy started before death in 15/ 20 (75%), invasive mold infection had a 60% overall mortality in patients with malignant disease.
- Published
- 1996
- Full Text
- View/download PDF
22. Fluconazole versus itraconazole in therapy of oropharyngeal candidiasis in cancer patients: a prospective comparative randomized trial.
- Author
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Studena V, Sycova Z, Helpianska L, Sorkovska D, Pichna P, Lacka J, Hlavacova E, Oravcova E, Krcmery V Jr, and Studena M
- Subjects
- Adult, Aged, Humans, Middle Aged, Prospective Studies, Antifungal Agents therapeutic use, Candidiasis, Oral drug therapy, Fluconazole therapeutic use, Itraconazole therapeutic use, Neoplasms complications, Pharyngeal Diseases drug therapy
- Published
- 1995
23. Nosocomial bacterial and fungal meningitis in cancer patients.
- Author
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Trupl J, Minarik T, Spanik S, Sufliarsky J, and Krcmery V Jr
- Subjects
- Adult, Cancer Care Facilities, Humans, Infection Control, Male, Middle Aged, Neutropenia chemically induced, Neutropenia complications, Risk Factors, Cross Infection etiology, Meningitis, Bacterial etiology, Meningitis, Fungal etiology, Neoplasms complications
- Abstract
Five cases of nosocomial meningitis are described that occurred within 5 years in a national cancer center in neutropenic cancer patients after cytotoxic chemotherapy: one caused by the yeast Aureobasidium mansoni and four caused by bacteria (two by Enterococcus faecalis and one by Salmonella enteritis and Arcanobacterium haemolyticus. Despite the severe symptoms, all cases were cured with appropriate antimicrobial therapy.
- Published
- 1995
- Full Text
- View/download PDF
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