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[Clinical analysis of neutropenic fever associated with hematological disorders]
1Division of Hematology and Infectious Diseases, Department of Medicine, Saitama Medical School.
Abstract:
We evaluated the efficacy of combination therapy with sulbactam/cefoperazone (SBT/CPZ) and amikacin sulfate (AMK) in eligible patients with hematological disorders of neutrophil count less than 1,000/microliter. The clinical efficacy rate in 157 evaluated patients was 65.6%. The clinical efficacy rates were related to neutrophil counts and serum albumin levels at the 1 week later. The clinical efficacy rates were 87.1% in patients with neutrophil counts over 500/microliter and 34.8% in patients with serum albumin levels under 3 g/dl after 1 week. G-CSF treatment were not significant but tended to be more effective in patients with sepsis, and the neutrophil counts increased significantly. The group using G-CSF before the antibiotic treatment had a high clinical efficacy rate. It is suggested that G-CSF is effective in patients with neutropenia with the high risk to infection and in those who already have severe infections.
Insights
Combination therapy with sulbactam/cefoperazone and amikacin sulfate showed a 65.6% efficacy in neutropenic patients. Granulocyte-colony stimulating factor (G-CSF) improved outcomes, especially when given before antibiotics.
Area of Science:
- Infectious Diseases
- Hematology
- Pharmacology
Context:
- Neutropenia (<1,000/microliter) increases infection risk in hematological disorders.
- Combination antibiotic therapy (sulbactam/cefoperazone and amikacin sulfate) is a common treatment approach.
- Granulocyte-colony stimulating factor (G-CSF) is used to increase neutrophil counts.
Purpose:
- To evaluate the clinical efficacy of combination therapy (SBT/CPZ + AMK) in neutropenic patients.
- To assess the impact of neutrophil counts and serum albumin levels on treatment outcomes.
- To determine the role of G-CSF in conjunction with antibiotic therapy for neutropenic infections.
Summary:
- A clinical efficacy rate of 65.6% was observed in 157 patients treated with sulbactam/cefoperazone and amikacin sulfate.
- Higher efficacy was linked to neutrophil counts >500/microliter (87.1%) and serum albumin levels >3 g/dl (34.8% at <3 g/dl).
- G-CSF treatment, particularly when administered before antibiotics, showed a trend towards improved efficacy and significant neutrophil count increases, suggesting benefit in high-risk and severe infection cases.
Impact:
- This study highlights the importance of baseline neutrophil counts and albumin levels in predicting treatment success for neutropenic infections.
- Findings suggest that G-CSF may be a valuable adjunct therapy, especially in patients with severe neutropenia or sepsis.
- Optimizing combination antibiotic therapy and considering early G-CSF intervention can improve clinical outcomes in vulnerable patient populations.