Abstract:
:In the current era of multidrug-resistant organisms, the clinical spectrum of Streptococcus pneumoniae infection remains unclear, especially in immunosuppressed patients with cancer. We sought to define the characteristics of pneumococcal bacteremia in patients who were receiving care at a comprehensive cancer center. All consecutive episodes of S. pneumoniae bacteremia between January 1998 and December 2002 were evaluated retrospectively. One hundred thirty-five episodes of pneumococcal bacteremia occurred in 122 patients. Sixty-three (52%) of 122 patients had hematologic malignancies; the others had solid tumors. The median Acute Physiology and Chronic Health Evaluation II score was 14 +/- 5. Twenty-four episodes (18%) occurred during neutropenia (<500 cells/microL). Sixty-five patients (53%) were receiving antineoplastic therapy, and 36 (30%) were receiving systemic corticosteroids. Twelve (41%) of 29 hematopoietic stem cell transplant (HSCT) recipients had received transplantation within 12 months of the infection diagnosis; 11 patients had graft-versus-host disease (chronic in 10). In 27 episodes (22%), S. pneumoniae bacteremia was considered as a breakthrough infection. Nine (56%) of 16 hospital-acquired episodes of S. pneumoniae bloodstream infection occurred in patients with profound neutropenia, whereas 15 (13%) of 119 episodes of community-acquired infection occurred during neutropenia (p < 0.0002). In 91 episodes (67%), patients had radiographic evidence of pneumonia. Infected catheters were associated with 21 episodes (16%). Forty-eight (36%) of 135 isolates were not susceptible to penicillin (minimum inhibitory concentration [MIC] > or = 2 microg/mL); 9 (7%) showed intermediate susceptibility to ceftriaxone (MIC >0.5 and <2.0 microg/mL). Nineteen patients (16%) died within 2 weeks of diagnosis; 18 deaths were attributed to systemic pneumococcal infection. Univariate analysis showed no significant increase in the risk of short-term death in patients with infection due to penicillin non-susceptible organisms (OR [odds ratio], 1.47; 95% confidence intervals [CI], 0.53-4.05; p < 0.46), initially discordant treatment (OR, 1.0; 95% CI, 0.62-665.4; p < 0.16), presence of pneumonia (OR, 1.19; 95% CI, 0.39-3.62; p < 0.76), neutropenia (OR, 1.0; 95% CI, 0.28-4.09; p < 0.92), systemic corticosteroid use (OR, 1.96; 95% CI, 0.69-5.60; p < 0.21), or antineoplastic therapy (OR, 1.45; 95% CI, 1.52-4.05; p < 0.47). Similarly, patients with hematologic cancers compared to those with solid cancers (OR, 1.0; 95% CI, 0.49-3.70; p < 0.56) and recipients of HSCT compared to those with no history of transplantation (OR, 1.0; 95% CI 0.59-12.71; p < 0.20) did not have a less favorable outcome. In conclusion, most pneumococcal bloodstream infections were community acquired, although hospital-acquired infections were common in neutropenic patients. It is noteworthy that initially discordant therapy, penicillin non-susceptible S. pneumoniae, and other conventional predictors of unfavorable outcome were not associated with increased mortality rates in these high-risk patients with cancer.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Kumashi P,Girgawy E,Tarrand JJ,Rolston KV,Raad II,Safdar Adoi
10.1097/01.md.0000180045.26909.29keywords:
subject
Has Abstractpub_date
2005-09-01 00:00:00pages
303-312issue
5eissn
0025-7974issn
1536-5964pii
00005792-200509000-00005journal_volume
84pub_type
杂志文章相关文献
MEDICINE文献大全abstract::Heart rate variability (HRV) is an objective measure of emotional regulation. This study aimed to estimate the accuracy with which an artificial neural network (ANN) algorithm could classify emotions using HRV data that were obtained using wristband heart rate monitors.Four emotions were evoked during gameplay: pleasu...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000016863
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Asthma is a common chronic disease with heavy burden. The number of asthma patients may continue to grow in the next 10 years. Existing conventional treatments have problems in which a small number of patients do not respond, often accompanied by side effects, or are too expensive. Probiotics, prebiotics, an...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000017840
更新日期:2019-11-01 00:00:00
abstract:INTRODUCTION:Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS:A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid p...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000017785
更新日期:2019-11-01 00:00:00
abstract::Fibrosing mediastinitis (FM) is a rare disorder characterized by the invasive proliferation of fibrous tissue within the mediastinum. FM frequently results in the compression of vital mediastinal structures and has been associated with substantial morbidity and mortality. Its pathogenesis remains unknown. However, in ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0b013e318237c8e6
更新日期:2011-11-01 00:00:00
abstract:INTRODUCTION:Contracture of dacryocyst by an implanted lacrimal silicone tube is rare. This report describes a unique case of secondary dacryocystitis and the contracture of dacryocyst caused by a lacrimal silicone tube that was placed in the lacrimal system for 10 years. PATIENT CONCERNS:A 63-year-old female was diag...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000023073
更新日期:2020-11-06 00:00:00
abstract::The aim of the study was to compare differences between lymphoma and inflammation as indicated by high diffuse uptake of F-fluorodeoxyglucose (F-FDG) in the spleen, liver, and bone marrow without increased F-FDG uptake in the lymph nodes and without enlarged peripheral lymph nodes.Eighteen lymphoma patients and 14 inf...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000003750
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:The blood-brain barrier is impaired in patients with stroke. The release of protein markers such as Sirtuin1 (SIRTl) into circulation may be useful to assess the prognosis of patients with cerebrovascular disease. In this study, we investigated the predictive value of SIRT1 levels in acute ischemic stroke (A...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000012959
更新日期:2018-12-01 00:00:00
abstract:RATIONALE:Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary colorectal tumor. Although cutaneous metastasis is unusual, it often indicates a poor prognosis. PATIENT CONCERNS:We treated a 62-year-old woman with multiple cutaneou...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000020026
更新日期:2020-05-22 00:00:00
abstract:RATIONALE:Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by rapidly progressive hypertension, headache, and disturbance of consciousness. Moreover, RPLS is rarely reported after apatinib treatment. PATIENT CONCERNS:We present a case of RPLS induced by apatinib in this report. The patient had...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000017787
更新日期:2019-11-01 00:00:00
abstract::Although the precise mechanisms underlying the pathogenesis of abdominal aortic aneurysm (AAA) remain unclear, aortic wall inflammation has been implicated in AAA development. Several studies have reported the use of fluoro-deoxyglucose (F-FDG)/positron emission tomography (PET) to assess the nature of AAA.We present ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000003650
更新日期:2016-05-01 00:00:00
abstract::This study is to investigate the methylation status of multiple tumor suppressor 1 (p16), secreted glycoprotein 2 (SLIT2), scavenger receptor class A, member 5 putative (SCARA5), and human runt-related transcription factor 3 (Runx3) genes in the peripheral blood of hepatocellular carcinoma (HCC).This is a case-control...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000008279
更新日期:2017-10-01 00:00:00
abstract::The dopamine transporter (DAT) plays a crucial role in the pathogenesis of alcohol dependence (AD) and major depression (MD), and males have more risk factors for the development of AD. However, imaging studies on brain DAT availability in males with AD comorbid with MD (AD/MD) are limited, and the association of DAT ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000004048
更新日期:2016-08-01 00:00:00
abstract::To investigate the effect of different dialysis modalities on the incidence of peripheral artery occlusive disease (PAOD) among patients with end-stage renal disease (ESRD) in a large population-based cohort study. The cohort study included 26,927 ESRD patients who underwent hemodialysis (17,737 patients, hemodialysis...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000001164
更新日期:2015-07-01 00:00:00
abstract::Revision total hip arthroplasty (THA) may cause intra- and postoperative massive bleeding. This prospective observational study evaluated if the maximum clot firmness of FIBTEM (MCFFIB) could act as a predictor of perioperative massive bleeding in revision THA.Fifty-eight adult patients undergoing revision THA were in...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000010929
更新日期:2018-06-01 00:00:00
abstract::The aim of this study was to study the ability of the genotype to predict impairment and disability in hospitalized ischemic stroke (IS) patients after hospital discharge and 6 months after the onset of stroke symptoms.A total of 786 patients with a first IS were enrolled. Apolipoprotein E (ApoE) polymorphism was exam...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000008964
更新日期:2017-12-01 00:00:00
abstract::Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with an increased risk of death compared to general population. Although previous studies showed improvement in survival of SLE, the long-term prognosis has not been elaborated in China.This study aims to integrate the observational studies estimating ...
journal_title:Medicine
pub_type: 杂志文章,评审
doi:10.1097/MD.0000000000000794
更新日期:2015-05-01 00:00:00
abstract:RATIONALE:Bickerstaff brainstem encephalitis (BBE) and Miller-Fisher syndrome (MFS) might be a pedigree disease. Herein, we report a rare case that fits the diagnoses of both MFS and BBE. PATIENT CONCERNS:A 48-year-old woman was hospitalized due to blurred vision and unsteady gait lasting for 9 days, and numbness of t...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000009824
更新日期:2018-03-01 00:00:00
abstract:RATIONALE:Primary gastric epithelioid angiosarcoma is a highly aggressive endothelial cell malignancy and may pose a great diagnostic challenge. PATIENT CONCERNS:Here we describe the case of a 56-year-old man presented with melena and epigastric dull pain for 2 weeks. DIAGNOSIS:Primary gastric epithelioid angiosarcom...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000010287
更新日期:2018-04-01 00:00:00
abstract::Immunotherapy with Bacillus Calmette-Guérin (BCG) is the most efficacious treatment for high-risk bladder cancer (BC) (Ta/T1 or carcinoma in situ) to reduce the risk of recurrence. Our aim was to evaluate whether hypertension and diabetes influence the outcome of patients with noninvasive BC treated with BCG instillat...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000000589
更新日期:2015-03-01 00:00:00
abstract:INTRODUCTION:Chimeric antigen receptor T cells (CAR-T) targeting CD19 have shown great potential for treatment of B-cell malignancies. For those patients who can not achieve complete remission (CR) or suffer from relapse after CAR-T therapy, further therapeutic strategies still remain elusive. Whether existing CAR-T ce...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000022510
更新日期:2020-10-23 00:00:00
abstract::This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS pati...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000012944
更新日期:2018-10-01 00:00:00
abstract:STUDY OBJECTIVE:Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the a...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000017994
更新日期:2019-11-01 00:00:00
abstract::Serum adiponectin levels have been suggested to be predictors of type 2 diabetes mellitus in diverse populations. However, the relationship between circulating adiponectin levels and the risk of development of type 2 diabetes in postmenopausal women has not been investigated.A total of 382 healthy postmenopausal women...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000001347
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Many studies were performed to explore the correlation between taxane-based chemotherapy and the risk of breast cancer-related lymphedema (BCRL), however, with inconsistent results. Hence, the purpose of this study is to evaluate whether taxane-based chemotherapy is a risk factor for BCRL. METHODS:A compreh...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000016563
更新日期:2019-07-01 00:00:00
abstract::To assess the role of circulating immune complexes (CIC) in chronic hepatitis C virus (HCV) infection, the relative frequency of CIC was determined in 60 patients with chronic hepatitis C alone, 19 patients co-infected with hepatitis B and C, 15 asymptomatic HCV carriers, and 54 healthy controls. Levels of CIC were de...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/00005792-199505000-00003
更新日期:1995-05-01 00:00:00
abstract::We aimed to evaluate the prognostic value of clinical and pathologic factors in rectal squamous cell carcinomas (SCC) and to construct a nomogram for their outcome prediction.The study cohort was selected from Surveillance, Epidemiology, and End Results (SEER) program between January 2004 and December 2013. Univariate...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000017916
更新日期:2019-11-01 00:00:00
abstract:INTRODUCTION:Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000020120
更新日期:2020-05-01 00:00:00
abstract::There is no known useful clinical parameter that can specifically predict a biliary stricture and differentiate it from other related complications after living donor liver transplantations (LDLT). The aims of this study were to determine whether the changes of liver enzymes can predict postoperative biliary stricture...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000006892
更新日期:2017-10-01 00:00:00
abstract::Few case series provide a current, comprehensive, and detailed description of splenic infarction (SI), an uncommon condition.Retrospective chart review complemented by imaging evaluation and patient follow-up.All adult patients with a confirmed diagnosis of acute SI discharged over 10 years from a single academic cent...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000001363
更新日期:2015-09-01 00:00:00
abstract:RATIONALE:Cutaneous vasculitis is usually found in patients with rheumatoid arthritis (RA) as an extra-articular manifestation, but rare in patients with ankylosing spondylitis (AS). In this case, we describe an AS patient who developed large skin lesions, of which the histological findings were consistent with cutaneo...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000014121
更新日期:2019-01-01 00:00:00