Poor Results of Pancreatoduodenectomy in High-Risk Patients with Endoscopic Stent and Bile Colonization are Associated with E. coli, Diabetes and Advanced Age

Abstract The Dana-Farber Cancer Institute (DFCI) Childhood ALL Consortium Protocol 95-01 was designed to minimize therapy-related morbidity for children with newly diagnosed ALL without compromising efficacy. Patients participated in randomized comparisons of (1) doxorubicin given with or without dexrazoxane, a cardioprotectant (high-risk patients), (2) intensive intrathecal chemotherapy and cranial radiation (standard-risk patients), and (3) Erwinia and Escherichia coli asparaginase (all patients). Between 1996 and 2000, 491 patients (aged 0-18 years) were enrolled (272 standard risk and 219 high risk). With a median of 5.7 years of follow-up, the estimated 5-year event-free survival (EFS) for all patients was 82% ± 2%. Dexrazoxane did not have a significant impact on the 5-year EFS of high-risk patients (P = .99), and there was no significant difference in outcome of standard-risk patients based on type of central nervous system (CNS) treatment (P = .26). Compared with E coli asparaginase, Erwinia asparaginase was associated with a lower incidence of toxicity (10% versus 24%), but also an inferior 5-year EFS (78% ± 4% versus 89% ± 3%, P = .01). We conclude that (1) dexrazoxane does not interfere with the antileukemic effect of doxorubicin, (2) intensive intrathecal chemotherapy is as effective as cranial radiation in preventing CNS relapse in standard-risk patients, and (3) once-weekly Erwinia is less toxic than E coli asparaginase, but also less efficacious.

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Emergence of quinolone-resistant Escherichia coli at a comprehensive cancer center

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19623 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19623-19623

Author(s):

K. V. Rolston ◽

E. Coyle ◽

R. Prince

Keyword(s):

High Risk ◽

Cancer Patients ◽

Broad Spectrum ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

E Coli ◽

High Risk Patients ◽

Resistance Patterns ◽

Risk Patients ◽

Febrile Episodes

19623 Background: Quinolone prophylaxis is recommended in high-risk neutropenic patients. Although effective in reducing the frequency of febrile episodes and documented gram-negative infections, this approach can lead to the emergence of resistant organisms. Surveillance studies looking for changes in resistance patterns at institutions that care for high-risk patients are also recommended. Methods: Our institution has participated in the meropenem yearly susceptibility test information collection (MYSTIC) program since 2000. The susceptibility of E. coli isolates from our cancer patients to quinolones (ciprofloxacin and levofloxacin) and broad-spectrum agents often used in empiric antimicrobial regimens in such patients, was determined. These studies were conducted by JMI Laboratories, Iowa, USA, and combined results as well as results of each participating institution were provided. CLSI designated breakpoints for susceptibility were used. Ribotyping and PFGE studies were performed on recent isolates. Results: Table 1 documents the declining susceptibility of E. coli isolates to the quinolones. In 2006 only 40.7% were quinolone susceptible compared to 84.2% in 2000 (p = 0.0032). All E. coli isolates remain susceptible to the carbapenems (meropenem, imipenem, ertapenem) and 95.5% remain susceptible to cefepime, ceftazidime, piperacillin-tazobactam, and the aminoglycosides. Twenty-one resistant E. coli isolates underwent ribotyping. Fourteen isolates showed identical ribotype and similar PFGE patterns suggesting the presence of an endemic clone. The other 7 isolates showed variability in their molecular patterns. Conclusions: Quinolone resistance among E. coli strains isolated from cancer patients has increased substantially. Fortunately these isolates remain susceptible to most broad-spectrum beta-lactams and aminoglycosides. Effective infection control methods need to be implemented and enforced in order to reduce the spread of these organisms in high risk patients. No significant financial relationships to disclose. [Table: see text]

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