Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

Clinical Nursing Research ◽

10.1177/1054773821999688 ◽

2021 ◽

pp. 105477382199968

Author(s):

Anas Alsharawneh

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Length Of Stay ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Emergency Setting ◽

Extended Length ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

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Cost-effectiveness of prophylactic granulocyte colony-stimulating factor for febrile neutropenia in breast cancer patients receiving FEC-D

Breast Cancer Research and Treatment ◽

10.1007/s10549-015-3309-3 ◽

2015 ◽

Vol 150 (1) ◽

pp. 169-180 ◽

Cited By ~ 7

Author(s):

Esther K. Lee ◽

William W. L. Wong ◽

Maureen E. Trudeau ◽

Kelvin K. W. Chan

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Breast Cancer Patients ◽

Stimulating Factor

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Lessons towards the roadmap on implementation and sustainability of cancer control actions

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1154 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T Albreht

Keyword(s):

Helicobacter Pylori ◽

Cancer Patients ◽

Stomach Cancer ◽

Antibiotic Treatment ◽

Joint Action ◽

Large Scale ◽

Cancer Control ◽

Research Activity ◽

Cancer Management ◽

Control Actions

Abstract The speaker will present the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action (JA), which is aiming to develop innovative approaches to advances in cancer control and a Roadmap on Implementation and Sustainability of Cancer Control Actions, identifying areas of relevance to AMR. The issue of AMR is an important issue in view of cancer management. It pertains both to the control of one of the pathogens clearly identified as conducive to cancer - Helicobacter pylori as well as to the issues arising from the vulnerability of the cancer patients in the course of oncological treatment. In the previous JA on Cancer Joint Action on Cancer Control (CanCon), an expert consensus process led to the conclusion that population-based screening for Helicobacter pylori, followed by antibiotic treatment at large scale could trigger AMR, even if it could offset some morbidity due to stomach cancer. It is clear that further research activity is necessary to explore this issue since stomach cancer remains a public health challenge. This is important because of late stage detection, resulting in poor survival. The other important issue is the need to protect cancer patients in treatment and beyond by securing effective antibiotic treatment for infections arising from their condition and/or following their treatment.

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