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Axel Glasmacher - One of the best experts on this subject based on the ideXlab platform.

  • Invasive fungal infections in Neutropenic Enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adult patients.
    BMC infectious diseases, 2006
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Ulrich Mey, Volker Schmitz, Christian Rabe, Katharina Pauls, Ingo Gh Schmidt-wolf, Axel Glasmacher
    Abstract:

    Background Neutropenic Enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal Neutropenic Enterocolitis.

  • Invasive fungal infections in Neutropenic Enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients
    BMC Infectious Diseases, 2006
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Ulrich Mey, Volker Schmitz, Christian Rabe, Katharina Pauls, Ingo Gh Schmidt-wolf, Axel Glasmacher
    Abstract:

    Background Neutropenic Enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal Neutropenic Enterocolitis. Methods Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal Neutropenic Enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal Neutropenic Enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature. Results Among 186 articles describing patients with Neutropenic Enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal Neutropenic Enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy. Conclusion In patients with Neutropenic Enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in Neutropenic Enterocolitis.

  • Neutropenic Enterocolitis in adults systematic analysis of evidence quality
    European Journal of Haematology, 2005
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Michael Schepke, Ingo G H Schmidtwolf, Tilman Sauerbruch, Axel Glasmacher
    Abstract:

    Abstract: Objective: Neutropenic Enterocolitis is a life-threatening complication occurring most frequently after intensive chemotherapy in acute leukaemias. The literature is heterogenous and a systematic review is lacking. Methods: Following a systematic search we categorised all relevant reports according to their quality and extracted evidence to answer the questions: Which diagnostic criteria are appropriate? What is the incidence of Neutropenic Enterocolitis? Are there good quality studies supporting specific interventions: Which empiric antimicrobial therapy is recommendable? Is Neutropenic Enterocolitis without surgical emergency complications an indication for bowel resection? Results: We found and analysed 145 articles of these reports: 64 were reports of single cases, 30 papers reported of two or three cases, 13 were narrative reviews, 34 were retrospective case series of more than three cases and four were prospective diagnostic studies. There were no prospective trials or case control studies on the therapy of Neutropenic Enterocolitis. There was no consensus on diagnostic criteria. We discuss the difficulty to define diagnostic criteria without having a disease definition. Histology is mostly not available in the living patients. We suggest applying a combination of clinical and radiological criteria: fever, abdominal pain and any bowel wall thickening >4 mm detected by ultrasonography (US) or computed tomography. We calculated a pooled incidence rate from 21 studies of 5.3% (266/5058; 95% CI: 4.7%–5.9%) in patients hospitalised for haematological malignancies, for high-dose chemotherapy in solid tumours or for aplastic anaemia. Conclusions: This systematic review provides diagnostic criteria for Neutropenic Enterocolitis, presents a quantitative synthesis on its incidence and discusses its treatment recommendations. Prospective studies are clearly warranted.

B E De Pauw - One of the best experts on this subject based on the ideXlab platform.

Mary L. Disis - One of the best experts on this subject based on the ideXlab platform.

  • American Journal of Hematology 72:204–208 (2003) Fatal Bacillus cereus Sepsis Following Resolving Neutropenic Enterocolitis During the Treatment of Acute Leukemia
    2013
    Co-Authors: Amy Sarah Ginsburg, Lupe G. Salazar, Lawrence D. True, Mary L. Disis
    Abstract:

    Bacillus cereus is increasingly being acknowledged as a serious bacterial pathogen in immunosuppressed hosts. We report a case of fatal B. cereus sepsis in a patient with newly diagnosed acute leukemia following resolving Neutropenic Enterocolitis. Gastrointestinal complaints are common during induction chemotherapy, yet some antimicrobial coverage suitable for generalized neutropenia is not optimal for the eradication of B. cereus. This case demonstrates that, in the Neutropenic patient with gastrointestinal complaints or in the setting of resolving Neutropenic Enterocolitis, it is important to anticipate possible B. cereus infection and sepsis. Am. J. Hematol. 72:204–208, 2003. © 2003 Wiley-Liss, Inc. Key words: Bacillus cereus; gastrointestinal; leukemia; neutropeni

  • Fatal Bacillus cereus sepsis following resolving Neutropenic Enterocolitis during the treatment of acute leukemia.
    American journal of hematology, 2003
    Co-Authors: Amy Sarah Ginsburg, Lupe G. Salazar, Lawrence D. True, Mary L. Disis
    Abstract:

    Bacillus cereus is increasingly being acknowledged as a serious bacterial pathogen in immunosuppressed hosts. We report a case of fatal B. cereus sepsis in a patient with newly diagnosed acute leukemia following resolving Neutropenic Enterocolitis. Gastrointestinal complaints are common during induction chemotherapy, yet some antimicrobial coverage suitable for generalized neutropenia is not optimal for the eradication of B. cereus. This case demonstrates that, in the Neutropenic patient with gastrointestinal complaints or in the setting of resolving Neutropenic Enterocolitis, it is important to anticipate possible B. cereus infection and sepsis.

Marcus Gorschluter - One of the best experts on this subject based on the ideXlab platform.

  • Invasive fungal infections in Neutropenic Enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adult patients.
    BMC infectious diseases, 2006
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Ulrich Mey, Volker Schmitz, Christian Rabe, Katharina Pauls, Ingo Gh Schmidt-wolf, Axel Glasmacher
    Abstract:

    Background Neutropenic Enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal Neutropenic Enterocolitis.

  • Invasive fungal infections in Neutropenic Enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients
    BMC Infectious Diseases, 2006
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Ulrich Mey, Volker Schmitz, Christian Rabe, Katharina Pauls, Ingo Gh Schmidt-wolf, Axel Glasmacher
    Abstract:

    Background Neutropenic Enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal Neutropenic Enterocolitis. Methods Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal Neutropenic Enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal Neutropenic Enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature. Results Among 186 articles describing patients with Neutropenic Enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal Neutropenic Enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy. Conclusion In patients with Neutropenic Enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in Neutropenic Enterocolitis.

  • Neutropenic Enterocolitis in adults systematic analysis of evidence quality
    European Journal of Haematology, 2005
    Co-Authors: Marcus Gorschluter, John Strehl, Carsten Ziske, Michael Schepke, Ingo G H Schmidtwolf, Tilman Sauerbruch, Axel Glasmacher
    Abstract:

    Abstract: Objective: Neutropenic Enterocolitis is a life-threatening complication occurring most frequently after intensive chemotherapy in acute leukaemias. The literature is heterogenous and a systematic review is lacking. Methods: Following a systematic search we categorised all relevant reports according to their quality and extracted evidence to answer the questions: Which diagnostic criteria are appropriate? What is the incidence of Neutropenic Enterocolitis? Are there good quality studies supporting specific interventions: Which empiric antimicrobial therapy is recommendable? Is Neutropenic Enterocolitis without surgical emergency complications an indication for bowel resection? Results: We found and analysed 145 articles of these reports: 64 were reports of single cases, 30 papers reported of two or three cases, 13 were narrative reviews, 34 were retrospective case series of more than three cases and four were prospective diagnostic studies. There were no prospective trials or case control studies on the therapy of Neutropenic Enterocolitis. There was no consensus on diagnostic criteria. We discuss the difficulty to define diagnostic criteria without having a disease definition. Histology is mostly not available in the living patients. We suggest applying a combination of clinical and radiological criteria: fever, abdominal pain and any bowel wall thickening >4 mm detected by ultrasonography (US) or computed tomography. We calculated a pooled incidence rate from 21 studies of 5.3% (266/5058; 95% CI: 4.7%–5.9%) in patients hospitalised for haematological malignancies, for high-dose chemotherapy in solid tumours or for aplastic anaemia. Conclusions: This systematic review provides diagnostic criteria for Neutropenic Enterocolitis, presents a quantitative synthesis on its incidence and discusses its treatment recommendations. Prospective studies are clearly warranted.

Gordon P. Buzby - One of the best experts on this subject based on the ideXlab platform.

  • Changing Presentation and Management of Neutropenic Enterocolitis
    Archives of Surgery, 1998
    Co-Authors: Howard K. Song, Robert J. Canter, Alexander S Krupnick, Edward A Stadtmauer, Daniel Kreisel, Gordon P. Buzby
    Abstract:

    Objective To characterize the current clinical presentation and management of Neutropenic Enterocolitis. Design Retrospective review of records of oncology unit patients requiring general surgical consultation for abdominal complaints in a 1-year period. Setting Oncology unit of a tertiary care, university teaching hospital. Patients and Interventions Fourteen patients diagnosed as having Neutropenic Enterocolitis were managed conservatively with operation reserved for failure of conservative therapy. Main Outcome Measures Clinical data from patients at the time of presentation and during treatment for Neutropenic Enterocolitis. Results All 14 patients diagnosed as having Neutropenic Enterocolitis were receiving chemotherapy for solid tumors or leukemias. Seven patients were undergoing stem cell or autologous bone marrow transplantation. Presenting symptoms and physical examination findings were nonspecific. All patients except one had neutropenia at the time of diagnosis. Computed tomographic scans of the abdomen were the most useful confirmatory study for the diagnosis of Neutropenic Enterocolitis. All patients except one had resolution of Neutropenic Enterocolitis with conservative therapy. One patient whose course of conservative management failed had protracted neutropenia and required operation for resection of bowel with full-thickness necrosis. Conclusions Neutropenic Enterocolitis has evolved from a complication of patients with leukemia to a disease of patients receiving high-dose chemotherapy for many malignancies, solid as well as hematologic. Diagnosis of Neutropenic Enterocolitis continues to be a challenge, as patients typically present with nonspecific gastrointestinal tract symptoms. Neutropenia and computed tomographic scan findings are useful adjuncts in diagnosing Neutropenic Enterocolitis. Timely conservative treatment frequently allows resolution of Neutropenic Enterocolitis without operation.