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V Fainstein

Publications and source records attributed to V Fainstein.

At least 37 records · Page 2Linked to original sources
PubMed1988

The emerging role of Fusarium infections in patients with cancer.

Infection due to Fusarium species is an increasing cause of serious potentially fatal disease in patients with cancer. We described 9 patients with infection caused by Fusarium species during a 4-year period at the M. D. Anderson Hospital. The spectrum of infections included disseminated disease in 4 patients, skin or soft-tissue infections in 3, pneumonia in 1, and fungemia in 1. All 4 patients with disseminated infection had culture- and biopsy-proven skin lesions caused by Fusarium species and the blood cultures yielded the organism in 3 of these 4 patients. Maxillary sinusitis was the presenting manifestation of Fusarium infection in 2 of these 4 patients, suggesting that paranasal sinuses are potential portals of entry for the infection. Eight patients had a hematological malignancy and 7 were neutropenic at the onset of their infection. Patients with deep-seated infections remained neutropenic and died from infection despite treatment with amphotericin B. All 5 isolates tested in vitro showed resistance to ketoconazole and miconazole, whereas 3 were susceptible to amphotericin B. Fusarium species could play a role in producing myelosuppression and fungal cultures are required to differentiate it from the more commonly encountered Aspergillus species. Fusarium species are emerging as a serious, potentially fatal, pathogen in patients with cancer.

Adolescent↗
PubMed1988

Wound prophylaxis with metronidazole in head and neck surgical oncology.

Anaerobic organisms are thought to be an important source of wound infection in head and neck oncologic surgery. Antibiotic prophylaxis consisting of agents specific for anaerobes combined with broad-spectrum agents that provide coverage for other well-recognized pathogens should be an effective combination regimen for this group of patients. We conducted a prospective, randomized study comparing the efficacy of prophylaxis using combination of metronidazole and cefazolin-designated group A, to prophylaxis using cefazolin alone-group B, for patients undergoing oncologic procedures of the head and neck. The rate of wound infection in the cefazolin-metronidazole group (158 patients) was 9.5%, compared with 18.6% in the cefazolin group (172 patients) (p = 0.03). Patients undergoing clean procedures had a 4.9% infection rate overall, compared with 17.9% for clean-contaminated procedures, and 33.3% for contaminated procedures. The average length of hospitalization was 20.7 days for patients who developed infections, compared with 8.9 days for patients without infection. Anaerobic organisms were cultured in 12 of 26 patients, ten of whom did not receive metronidazole. The lower rate of wound infection among patients who received metronidazole suggests that anaerobic organisms are an important source of wound infection in head and neck oncologic surgery. Chemoprophylaxis for these patients should, therefore, include specific anaerobic coverage in addition to the broad-spectrum agents that cover the more familiar aerobic organisms.

Bacteria, Anaerobic↗
PubMed1987

Imipenem/cilastatin therapy of infections in cancer patients.

Imipenem/cilastatin was administered during 153 febrile episodes occurring in cancer patients and the response rate was 68%. Considering only documented infections the response rate was 71%. Patients who received imipenem as initial therapy had a higher response rate than patients who received it after failing other antibiotics (77% versus 68%). The overall response rates for septicemias and pneumonias were 75% and 58%. Among the 57 gram-negative infections 77% responded, but the response rate was substantially higher if imipenem was used as initial therapy (94% versus 69%). The poorest response rate was observed when imipenem was given as secondary therapy for Pseudomonas infections (50%), but most of these patients had failed to respond to other appropriate antibiotics. The only serious side effect was seizures which occurred in ten patients, although eight of them had other predisposing factors. Imipenem appears to be a useful antibiotic for treatment of infections, even in neutropenic cancer patients.

Adolescent↗
PubMed1987

Pseudomonas putida. Newly recognized pathogen in patients with cancer.

Pseudomonas putida was recovered from blood culture specimens between 1980 and 1985 in 15 patients with cancer. No isolates were found in specimens obtained before 1980. Eight patients were considered to have septicemia (more than one positive blood culture result plus clinical signs of infection). Septicemia was monomicrobial in three of those eight patients and polymicrobial in five. Of these eight patients, one had pneumonia and three had phlebitis, cellulitis, or both at the site of the venous catheter. The infection appeared to be catheter-related in these three patients, with response to catheter removal in one patient, response to catheter removal and antibiotics in one patient, and response to antibiotics alone in one patient. P. putida was isolated from the site of insertion and the tip of the catheter in one of these three patients. Following therapy, all patients had a rapid recovery from their infection. In vitro susceptibility testing revealed that 90 percent of the isolates were susceptible to piperacillin, ceftazidime, imipenem, and ciprofloxacin.

Catheterization↗
PubMed1987

Ceftizoxime plus ticarcillin: double beta-lactam therapy for infections in cancer patients.

Eighty-one febrile episodes in cancer patients with adequate neutrophil counts (greater than 1000/microliter) were treated with a double beta-lactam combination of ceftizoxime plus ticarcillin. Fifty-four episodes were microbiologically documented and 27 were clinically documented. The overall response rate was 75% (61 of 81). The response rate in 38 episodes where a single organism was identified was 71%. Polymicrobial infections were associated with a high response rate of 87%. Responses occurred in six of eight Gram-positive and 21 of 30 Gram-negative infections. Pneumonia was the most frequent infection and was associated with a response of 61%. Septicaemia and urinary tract infections also occurred commonly and had response rates of 76% and 89% respectively. All but one organism were susceptible to at least one of the antibiotics. No resistant organisms emerged during therapy. Side-effects included rash (1), phlebitis (3), and coagulation abnormalities without bleeding (3). Four patients developed superinfections (three bacterial, one fungal). The double beta-lactam combination of ceftizoxime plus ticarcillin was safe and effective therapy for infections in non-neutropenic cancer patients.

Adult↗
PubMed1987

Amphotericin B or ketoconazole therapy of fungal infections in neutropenic cancer patients.

Fungal infections in neutropenic cancer patients have increased in frequency and constitute an important cause of morbidity and mortality. Empiric antifungal therapy is often administered to those patients who have failed to respond to antibacterial antibiotics. We conducted a prospective, randomized trial of amphotericin B and ketoconazole for 172 neutropenic cancer patients with presumed or proven fungal infections. Overall, amphotericin B and ketoconazole were equally effective. Amphotericin B may have been more effective than ketoconazole for the treatment of pneumonia. Also, five of eight Candida tropicalis infections treated with amphotericin B responded, whereas all eight infections treated with ketoconazole failed to respond (P = 0.03). Response rates for localized fungal infections were similar with both drugs. Ketoconazole should not be used as empiric antifungal therapy at institutions where there is a high frequency of infections caused by Aspergillus spp. or C. tropicalis because this agent lacks activity in vitro against these species.

Adolescent↗
PubMed1987

Disseminated Geotrichum candidum infection.

The pathogenicity of the fungus Geotrichum candidum in humans has not been clearly defined. A patient with acute leukemia who developed a fatal disseminated G. candidum infection while neutropenic is described. At autopsy examination, this patient was misdiagnosed on the basis of histopathology as having disseminated candidiasis until G. candidum was isolated from postmortem culture specimens. The emergence of this organism as an occasional pathogen in leukemic patients is of interest and illustrates the importance of obtaining fungal cultures. There is a need for more effective drugs for antifungal prophylaxis and therapy.

Agranulocytosis↗
PubMed1986

Cryptosporidiosis.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Aztreonam therapy in neutropenic patients with cancer.

Combinations of aztreonam/vancomycin, aztreonam/vancomycin/amikacin, and moxalactam/ticarcillin were compared in a prospective randomized trial as empiric therapy for febrile neutropenic cancer patients. Vancomycin was added to aztreonam to provide coverage against gram-positive organisms. Of 535 febrile episodes included in the study, 455 were evaluable. The aztreonam/vancomycin and aztreonam/vancomycin/amikacin combinations were both more effective than the moxalactam/ticarcillin combination in a total of 244 episodes of documented infection. The difference was due to the fact that both aztreonam-containing combinations were more effective than the moxalactam/ticarcillin combination in documented gram-positive infections. The three regimens were equally effective in 67 documented infections due to a single gram-negative bacterial species. (The response rates were 87, 86 and 94 percent for the aztreonam/vancomycin, aztreonam/vancomycin/amikacin, and moxalactam/ticarcillin combinations, respectively.) Aztreonam was effective as the single active antibiotic in the treatment of gram-negative infections in neutropenic patients; however, it must be used in combination with another antibiotic to provide gram-positive coverage.

Adolescent↗
PubMed1986

Semiquantitative cultures of intravascular catheters from cancer patients.

Three-hundred seventy-nine catheter tips were prospectively cultured by both a semiquantitative method and by broth culture, over a 2-month period. One hundred eleven of the catheters were culture-positive in broth, and 47 of these were also culture-positive by the semiquantitative method. Clinical signs of infection were reviewed for the 111 culture-positive catheters and for 50 of the 268 culture-negative catheters. Both culture-positive and culture-negative catheters were infrequently associated with local signs of infection (10% and 12%, respectively). Culture-positive catheters, however, were more likely to be associated with systemic signs of infection than were culture-negative catheters (15% and 2%, respectively). Among the culture-positive catheters, those that yielded greater than or equal to 15 colonies on semiquantitative culture were more likely to be associated with septicemias than were those with less than 15 colonies (22% and 6%, respectively). Nevertheless, there were five catheter-related bacteremias that were associated with catheters which were culture-negative on semiquantitative culture but culture-positive in broth. The proportion of patients with culture-positive and culture-negative catheters who were febrile was similar (30% and 42%, respectively). Semiquantitative cultures of catheters from cancer patients are useful, but the result should be interpreted with some caution.

Bacterial Infections↗
PubMed1986

Imipenem/cilastatin as secondary therapy for infections in cancer patients.

Imipenem/cilastatin was used to treat 68 documented infections in patients who had failed to respond to other antibiotic regimens. The overall response rate was 68% and was higher among patients in whom the infecting organism could be identified (71% vs. 60%). The response rates were 73% in the 37 cases of septicaemia and 54% in the 13 cases of pneumonia. The response rate in Gram-negative bacillary infections was 69%, but was 50% for those caused by Pseudomonas aeruginosa. The response rate did not correlate with patients' neutrophil counts, but was higher if the neutrophil count increased during therapy than if it decreased (86% vs. 48%, P = 0.001). The drug was well tolerated but one patient developed seizures. Imipenem/cilastatin appears to be a useful antibiotic as single agent therapy for most infections in cancer patients.

Adolescent↗
PubMed1986

Polymicrobial septicemia in the cancer patient.

The medical records of 507 patients with polymicrobial septicemia were examined to determine prognostic and descriptive factors. Over 50% of the episodes occurred in patients with solid tumors and 80% originated during hospitalization. Invasive procedures and immunosuppressive therapy frequently preceded development of polymicrobial septicemia, and infection was often accompanied by shock and pneumonia. A majority of infections were caused by at least 1 aerobic gram-negative bacillus (76%) and anaerobic infections were not infrequent. Overall response among these patients was 50%, with poorest response seen among patients with persistent neutropenia (25%), pneumonia (19%), and gram-negative bacillary infection (46%). Therapy with an antibiotic regimen to which all causative organisms were sensitive was of greatest prognostic significance. Response to appropriate therapy was 58%, whereas only 10% of those who received inappropriate therapy were cured (p less than .0001).

Adolescent↗
PubMed1986

Imipenem-cilastatin as initial therapy for febrile cancer patients.

Imipenem-cilastatin was used to treat 79 febrile episodes in 71 cancer patients, most of whom had neutropenia. The overall response rate was 67%, and 76% of the 45 documented infections responded. The response rates for septicemias and pneumonias were 79 and 62%, respectively. Only 1 of the 17 infections caused by gram-negative bacilli failed to respond to this therapy. The most common side effects were skin rash, nausea, and diarrhea. Eight superinfections were detected during therapy.

Adult↗
PubMed1986

Infections of the gastrointestinal tract in the immunocompromised patient.

Immunocompromised patients are susceptible to a variety of serious gastrointestinal infections. Among the most common or most severe are Mycobacterium avium-intracellulare, herpes simplex, candidiasis, cryptosporidiosis, and Salmonellosis. Some of these infections are difficult or impossible to treat successfully. The correct diagnosis often can only be established if it is first suspected and the appropriate studies are performed.

Acquired Immunodeficiency Syndrome↗