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Biomedical subjects

F Meunier

Publications and source records attributed to F Meunier.

At least 109 records · Page 6Linked to original sources
PubMed1988

Gram-positive infections in granulocytopenic patients: an important issue?

Gram-positive pathogens have become a common cause of bacteraemia in granulocytopenic cancer patients. This has been partially attributed to the use of central intravenous devices such as Hickman catheters; mucositis secondary to intensive antineoplastic chemotherapy or herpes infections may also be the source, especially for streptococci, whereas the skin is most probably the source for Staphylococcus epidermidis. Antimicrobial prophylaxis recommended mainly with the aim of reducing the incidence of Gram-negative bacillary infections may also play a significant role. The rate of response of documented infections caused by Gram-positive cocci to 'standard' empirical therapy (which has been mainly directed against Gram-negative bacilli) has been unsatisfactory although the lethality reported has been low. These results raise an important question, whether or not a specific anti-Gram-positive antibiotic such as vancomycin, should be added to the empirical regimen. A recent study suggested that empirical vancomycin provided no benefit since the mortality due to Gram-positive infections was low and a favourable outcome was obtained by adding a specific antibiotic after bacteriological documentation. However, others have shown that empirical use of vancomycin was associated with a more rapid resolution of fever. Vancomycin has been associated with an excess rate of side-effects and is difficult to administer. Another important question is whether or not antimicrobial prophylaxis for gut decontamination should include anti-Gram-positive cover. Recent studies have confirmed that Gram-negative bacillary bacteraemia may be prevented by oral gut decontamination but not bacteraemia due to Gram-positive bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Agranulocytosis↗
PubMed1988

Antimicrobial prophylaxis for major head and neck surgery in cancer patients.

A total of 113 patients were randomly allocated to receive either ticarcillin plus clavulanic acid (total dose, 20.8 g) or clindamycin (total dose, 2.4 g) plus amikacin (total dose, 1 g) as perioperative antimicrobial prophylaxis for major head and neck surgery. The two groups were similar in age, prior antineoplastic treatment (surgery, chemotherapy, and radiotherapy) or tracheostomy, and the various types of surgery including radical neck dissection. The wound infection rate was 10% in the group of patients receiving clindamycin plus amikacin and 36% in the group receiving ticarcillin plus clavulanic acid (P less than 0.05). Initiation of systemic antibiotic therapy within 15 days of surgery was necessary for 20 and 45% of these patients, respectively (P less than 0.05). The distribution of microorganisms causing wound infections was comparable in both groups, except for anaerobes, which were isolated predominantly from patients who had received ticarcillin plus clavulanic acid.

Adult↗
PubMed1988

Empiric antimicrobial therapy for febrile granulocytopenic cancer patients: lessons from four EORTC trials.

The results of the four EORTC trials conducted over the past 15 years suggest: (1) early empiric therapy with broad spectrum antibiotics directed against gram-negative bacterial bacteremia (GNBB) is a reasonable approach in febrile granulocytopenic patients (GCP); (2) the level and dynamics of the granulocyte count are extremely important in determining the outcome of bacteremia; severely and/or persistently neutropenic patients are the true tests of antibiotic efficacy and they benefit from antimicrobial synergism; (3) mortality from GNBB in GCP is not related directly to a given empiric antimicrobial regimen which may 'buy time' and allow appropriate therapeutic alterations; (4) only microbiologically documented infections and especially bacteremias are useful to compare responses to antimicrobial regimens; (5) the response rate of GNBB is clearly influenced by the susceptibility of the causative pathogen to the beta-lactam component of the empiric regimen and emergence of resistance to some antibiotics (cephalothin, carbenicillin, ticarcillin, azlocillin) has rendered some combinations less effective. The combination of an anti-Pseudomonas beta-lactam plus an aminoglycoside is recommended as the 'standard' for empiric therapy in febrile GCP; (6) gram-positive pathogens have become a common cause of bacteremia in GCP and although the response rate to empiric regimens may be marginal, the associated mortality is low. A general conclusion from these trials is that studies of the management of infection in GCP should include sufficient numbers of eligible patients to allow for evaluation of bacteremic patients at highest risk of death. The need for large collaborative studies stems directly from these considerations.

Agranulocytosis↗
PubMed1987

Ceftazidime combined with a short or long course of amikacin for empirical therapy of gram-negative bacteremia in cancer patients with granulocytopenia.

To determine whether combination antibiotic therapy including a short course of an aminoglycoside was as effective and less toxic than a conventional long course of the combination for the empirical therapy of gram-negative bacteremia in patients with cancer and granulocytopenia, we conducted a randomized multicenter trial comparing ceftazidime plus a short course (three days) of amikacin, ceftazidime plus a long course (nine days) of amikacin, and azlocillin plus a long course (nine days) of amikacin. Single-organism gram-negative bacteremia occurred in 129 of 872 evaluable patients. Without a change in antibiotics, the response rates were 81 percent with ceftazidime and long-course amikacin, 48 percent with ceftazidime and short-course amikacin (P = 0.002), and 40 percent with azlocillin and long-course amikacin (P less than 0.001). Among patients with fewer than 100 granulocytes per cubic millimeter throughout therapy, the response rates were 6 percent with ceftazidime and short-course amikacin and 50 percent with ceftazidime and long-course amikacin (P = 0.03). Linear logistic-regression analysis showed that therapy with ceftazidime and long-course amikacin was the most favorable prognostic factor of the response to infection, whereas the presence of leukemia or shock was the least favorable. We conclude that ceftazidime should be given in combination with a conventional full course of an aminoglycoside (amikacin) when used for the empirical treatment of gram-negative bacteremia in cancer patients with granulocytopenia.

Adolescent↗
PubMed1987

Pharmacokinetics of gentamicin after i.v. infusion or iv bolus.

A cross-over randomized comparative study was undertaken in ten healthy subjects to study the pharmacokinetics of 80 mg of gentamicin given as a bolus iv injection or as an infusion over 15 min using a commercially available 100 ml solution. Mean peak values at the end of the two modes of injection were respectively: 17.8 and 7.8 mg/l (P less than or equal to 0.002, Wilcoxon ranked pairs test). Mean peak values extrapolated at t = 0 for each volunteer were respectively 4.2 and 3.8 mg/l (not statistically different). Mean serum values 1 h after administration were respectively 4.2 and 3.7 mg/l (not statistically different). Mean trough values after 8 h were: 0.45 and 0.44 mg/l. Mean elimination half-lives were 139 and 142 min (P greater than 0.1).

Adult↗
PubMed1986

Empiric antimicrobial therapy with aztreonam or ceftazidime in gram-negative septicemia.

In an open, comparative study, 225 patients with severe underlying diseases and suspected gram-negative bacillary septicemia were randomly assigned to receive aztreonam or ceftazidime empirically, 2 g intravenously three times daily. Twenty-five patients in the aztreonam group and 22 in the ceftazidime group had blood cultures that grew aerobic gram-negative bacilli and were evaluable for response to therapy. All pathogenic strains were sensitive to treatment. In the aztreonam group, 22 (88 percent) patients had cures, three (12 percent) had failures, and seven (28 percent) had development of superinfections (five were caused by gram-positive cocci and two by fungi). In the ceftazidime group, 18 (82 percent) patients had cures, one had improvement, three (14 percent) had failures, and three had superinfections. The median peak serum bactericidal activity was 1:2,048 after aztreonam administration and 1:512 after ceftazidime administration. Failures were not related to resistant strains or to low serum bactericidal activity.

Adult↗
PubMed1986

Serum fungistatic and fungicidal activity in volunteers receiving antifungal agents.

The serum levels of two imidazoles, ketoconazole and Bayer n7133, when administered alone or in combination with rifampin, were measured in volunteers and the serum antifungal activity was determined against various fungal strains. Serum levels were measured by high pressure liquid chromatography and correlated with serum fungistatic activity as determined in microtiter plates. Ketoconazole showed a wide range of serum levels, suggesting individual variations. The addition of two doses of rifampin significantly decreased serum levels of both imidazoles and no synergism was observed. Serum fungicidal activity could only occasionally be demonstrated against one strain of Candida albicans and Candida stellatoidea. Serum fungistatic activity significantly correlated with the serum levels of both imidazoles. This approach should be investigated in patients to establish its potential clinical relevance for managing invasive fungal infections.

Aspergillus fumigatus↗
PubMed1986

Empirical antimicrobial therapy with Timentin plus amikacin in febrile granulocytopenic cancer patients.

Timentin (ticarcillin plus clavulanic acid) plus amikacin was administered as an empirical regimen to 52 febrile granulocytopenic patients with cancer and appeared as effective as the other commonly recommended combinations of antimicrobial agents. A favourable response was observed in 61% of episodes with bacteraemia and in 83% of the episodes without bacteraemia. However, the efficacy in Gram-positive bacteraemia was suboptimal and the emergence of superinfections caused by Gram-positive cocci may represent a clinical challenge.

Adult↗
PubMed1986

In vitro evaluation of various antifungal agents alone and in combination by using an automatic turbidimetric system combined with viable count determinations.

A new method combining automatic turbidimetry and sequential viable count determinations was developed to evaluate the in vitro activity of various antifungal agents alone and in combination against three clinical isolates of Candida spp. (two Candida albicans and one C. tropicalis) at two inocula (10(-5) and 10(-6) CFU/ml). Specific parameters were derived from the time-kill curves: the maximal rate of killing, the lowest biomass, and the overnight biomass. Their intra-assay and between-assay reproducibilities were high, with respective standard deviations of 0.4 and 0.25 to 1.4 log CFU/ml. Amphotericin B alone showed a linear relationship between rate of killing or lowest biomass and the log of concentration from 0.03 to 4 mg/liter that was similar for the three strains tested. 5-Fluorocytosine (flucytosine) alone showed a dose-related reduction of overnight biomass for concentrations up to 8 mg/liter with no further increase at higher concentrations for one strain of C. albicans and a paradoxical decrease for one strain of C. tropicalis. Ketoconazole alone was found to be only fungistatic with no increased activity at concentrations up to 16 mg/liter. Amphotericin B plus flucytosine interacted synergistically in 46 to 60% of the combinations tested against C. tropicalis depending on the initial inoculum. Indifference was observed for the two strains of C. albicans. Amphotericin B or flucytosine plus ketoconazole was usually indifferent against the three tested strains.

Amphotericin B↗
PubMed1984

Single-drug versus combination empirical therapy for gram-negative bacillary infections in febrile cancer patients with and without granulocytopenia.

Empirical therapy with cefoperazone was compared with cefoperazone plus amikacin in granulocytopenic and nongranulocytopenic febrile patients. In nonneutropenic patients the overall response rate to cefoperazone was 88%; 10 of 12 gram-negative bacteremic patients were cured. Cefoperazone plus amikacin resulted in an 88% overall response rate and cured 14 of 15 patients with bacteremia. In neutropenic patients the overall response rate was 77% with cefoperazone alone and 73% with cefoperazone plus amikacin; the cure rates for gram-negative bacteremias were 8 of 11 and 6 of 12 patients, respectively. Our findings support the concept of single-drug empirical therapy with cefoperazone in febrile cancer patients, whether granulocytopenic or not, especially when gram-negative bacteremias are predominantly caused by Escherichia coli or Klebsiella species. The issue of Pseudomonas spp. and other more resistant pathogens needs further assessment with a larger number of patients.

Adolescent↗
PubMed1984

[Stapedovestibular otospongiosis beginning in the cochlea. Apropos of 3 cases].

Stapedovestibular ankylosis developed after a prolonged course of pure perception deafness in 3 patients, suggesting possible secondary fixation of the stapes from otospongiosis restricted to the cochlear up to that time. A precise diagnosis of pure cochlear otospongiosis is always difficult to make, its presence usually being supposed rather than confirmed in spite of clinical, audiometry and radiology data, except in those few cases where secondary ankylosis of the foot of the stapes occurs. These findings suggested the need for regular audiometric surveillance of all patients with perception deafness.

Audiometry↗
PubMed1984

[Isolated fractures of the branches of the stapes. Apropos of 2 cases].

Isolated fractures of the limbs of the stapes are relatively rare when compared with other traumatic lesions of the ossicula. Diagnosis, as in two recent cases, is suggested by the history of injury and the persistence of a recordable stapes reflex. Surgical re-establishment of transmission is simple but results are not always as spectacular as might be expected.

Adult↗