Zavrelova Alzbeta, Paterova Pavla, Zak Pavel, Visek Benjamin, Sima Martin, Radocha Jakub
4 Department of Internal Medicine - Haematology, University Hospital and Charles University Faculty of Medicine, Hradec Kralove, Czech Republic.
Department of Clinical Microbiology, University Hospital and Charles University Faculty of Medicine, Hradec Kralove, Czech Republic.
Mediterr J Hematol Infect Dis. 2023 Jan 1;15(1):e2023001. doi: 10.4084/MJHID.2023.001. eCollection 2023.
sepsis in immunocompromised patients is a serious complication of cancer treatment, especially in the case of an Extensively Drug Resistant (XDR) pathogen. The aim of the study is to evaluate the efficacy of high-dose ceftazidime in the treatment of XDR infection and to compare it with the conventionally treated cohort in hemato-oncological patients.
We identified 27 patients with XDR infection during the 2008-2018 period, 16 patients served as a conventionally treated cohort with an antipseudomonal beta-lactam antibiotic in standard dose (cohort A), and 11 patients were treated with high-dose ceftazidime (cohort B). Most of the patients were neutropenic and under active treatment for their cancer in both cohorts.
Mortality and related mortality were statistically significantly better for cohort B than cohort A; it was 18.2% and 9.1% for cohort B and 68.8% and 68.8% for cohort A, respectively. More patients in cohort A needed mechanical ventilation and renal replacement therapy, 75% and 50% for cohort A and 27.3% and 9.9% for cohort B, respectively. It corresponded well with the worst sequential organ failure score (SOFA) in cohort A compared to cohort B, 16 versus 7, respectively. Reversible neurotoxicity was seen only in two patients in cohort B.
Ceftazidime in high doses is a very potent antibiotic (ATB) for treating XDR infections in neutropenic cancer with acceptable toxicity.
免疫功能低下患者的败血症是癌症治疗的严重并发症，尤其是在广泛耐药（XDR）病原体感染的情况下。本研究的目的是评估高剂量头孢他啶治疗XDR感染的疗效，并将其与血液肿瘤患者的传统治疗队列进行比较。
我们确定了2008年至2018年期间27例XDR感染患者，16例患者作为标准剂量抗假单胞菌β-内酰胺抗生素的传统治疗队列（A组），11例患者接受高剂量头孢他啶治疗（B组）。两组中的大多数患者均为中性粒细胞减少症患者且正在积极接受癌症治疗。
B组的死亡率和相关死亡率在统计学上显著低于A组；B组分别为18.2%和9.1%，A组分别为68.8%和68.8%。A组更多患者需要机械通气和肾脏替代治疗，A组分别为75%和50%，B组分别为27.3%和9.9%。这与A组与B组相比最差的序贯器官衰竭评分（SOFA）相符，分别为16分和7分。仅在B组的两名患者中观察到可逆性神经毒性。
高剂量头孢他啶是一种治疗中性粒细胞减少性癌症患者XDR感染的高效抗生素，且毒性可接受。
