We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.
Amikacin* ; Febrile Neutropenia ; Humans ; Mortality

Objective: To evaluate the clinical and microbiological profile and factors affecting outcome among pediatric febrile neutropenic (FN) patients with hematologic malignancies (HM) Methodology: This was a cross-sectional study which looked into medical records of Filipino children 0-18years old diagnosed with FN and HM and admitted from June 2016 up to June 2022 at the St. Luke’s Medical Center, Quezon City (SLMC-QC). Data on age, sex, underlying malignancy, stage of treatment, site of infection, presence of central line, initial antibiotic therapy, culture positivity and isolates were retrospectively evaluated. Incomplete records were excluded. The relationship between clinical & microbiologic profile and outcomes were analyzed using T-test and Chi-square test. Significance was set at p<0.05. Results This study included 267 episodes of FN. Patients had a mean age of 8.3 years with male preponderance (59%). The most frequent underlying malignancy was acute lymphoblastic leukemia (61%). Episodes occurred primarily during the induction (40%) and consolidation phases (28%) of chemotherapy. Most (65%) had an absolute neutrophil count (ANC) of <100/mm3 . Central line catheter was present in 59% of episodes and 52% had an implanted port. There was no identifiable focus of infection in 52% of cases. Gram-negative bacteria, specifically Klebsiella pneumoniae (13%) and Escherichia coli (11%) were the most common isolates. Most patients (88%) recovered. Age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection were significantly associated with duration of hospital stay. Presence of central venous line was the most significant factor associated with mortality. Conclusions: Several clinical and microbiological factors, specifically age >10years, male sex, diagnosis of acute myelogenous leukemia, relapse disease, ANC <100/mm3 , presence of a central line, and central line associated bloodstream infection, were documented to significantly affect outcome in Filipino pediatric FN patients with HM.
Febrile Neutropenia ; Hematologic Neoplasms ; Leukemia

PURPOSE: Cefepime is a new broad-spectrum antibiotics and is available as initial monotherapy in the management of pediatric cancer patients with febrile neutropenia. The aim of this study is to evaluate the efficacy of Cefepime monotherapy and piperacillin-tazobactam plus gentamicin combination therapy as an initial empirical antibiotics treatment in pediatric cancer patients with febrile neutropenia. METHODS: From January 2003 to July 2004, a total of 55 episodes of febrile neutropenia were analyzed retrospectively for this study. They were treated intravenous Cefepime (50 mg/kg every 8 hour) or piperacillin-tazobactam (90 mg/kg every 8hour) plus gentamicin (2.5 mg/kg every 8hour). Modification of antibiotics was done at 72~96 hour if fever persisted. Clinical responses were evaluated at the completion of therapy. RESULTS: Twenty-eight patients in the cefepime monotherapy and twenty-seven patients in the piperacillin-tazobactam plus gentamicin combination therapy were evaluable for efficacy. Modification of the empirical initial antibiotics therapy was done for 53% in the cefepime monotherapy group compared with 33.3% in the piperacillin-tazobactam plus gentamicin combination therapy group. The modification rate was not statistically significance between the treatment groups (P=0.130). And the overall success rate was 92.9% in cefepime monotherapy and 96.3% in piperacillin-tazobactam plus gentamicin combination therapy. So, there was no significant difference in success rate between two groups (P=0.514). A drug-related adverse event was reported in 1 case of piperacillin-tazobactam plus gentamicin combination therapy. There was no major adverse event. CONCLUSION: The empirical regimen of cefepime monotherapy is at least as effective as the regimen of piperacillin-tazobactam plus gentamicin combination therapy in pediatric malignancy patient with febrile neutropenia.
Anti-Bacterial Agents ; Febrile Neutropenia* ; Fever ; Gentamicins* ; Humans ; Retrospective Studies

Introduction: Febrile neutropenia (FN) is a common complication of immunocompromised patients – whether due to infection, cancer, drug-induced, or other bone marrow failure states. With the incidence of patients with immunocompromised states on the rise, this life threatening complication is also increasing. The importance of initiating the appropriate empiric antibiotic therapy can prove to be lifesaving, thus we examined how the initial choice of antibiotics influenced patient outcomes. This study aims to determine the effect of adherence to guideline-based antimicrobial therapy for adult febrile neutropenia patients in terms of patient outcomes. Methods: This is a 10-year cross-sectional analytical study which was conducted at the Dr. Pablo O. Torre Memorial Hospital (DPOTMH) by doing a retrospective chart review involving adult patients with FN from 2007 to 2016. We determined use of guideline-based antibiotics, examined the factors that influenced adherence, and investigated the effect of initial treatment on patient outcome. Results: Among the 257 adult patients with FN included in the study, Infectious Diseases Society of America (IDSA) guideline-based antibiotics were administered to 65%. On multivariate analysis, the most powerful predictor of adherence to guideline-based antibiotics was the type of risk (p=0.000), with high risk patients thrice more likely to be given guideline-based antibiotics. Other predictors were physician specialty (p=0.036) and hematologic malignancy (p=0.045). This study showed that among low risk patients with FN, a trend towards patient discharge was observed (OR 1.18, CI=0.16–8.63). However overall, adherence to guidelinebased empiric antibiotic in treating adult FN patients did not correlate to patient discharge (p=0.134, OR 0.557, 95% CI=0.260-1.205). Conclusion Our data suggest that adherence to guidelinebased antibiotics in managing adult Filipino patients with febrile neutropenia does not correlate to better outcomes such as patient discharge. Significant factors associated with adherence to guideline-based antibiotics are physician specialty, hematologic malignancy, and type of risk.
Guideline ; Anti-Bacterial Agents ; Febrile Neutropenia ; Neoplasms ; Patients

PURPOSE: We investigated the efficacy and safety of a combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line palliative chemotherapy for elderly patients with metastatic or recurrent gastric cancer. MATERIALS AND METHODS: The study patients were chemotherapy-naive patients (> 65 years old) with histologically confirmed, metastatic or recurrent gastric cancer. Chemotherapy consisted of oxaliplatin 100 mg/m2 and FA 100 mg/m2 (2-hour infusion), and then 5-FU 2400 mg/m2 (46-hour continuous infusion) every 2 weeks. RESULTS: A total of 37 patients were studied between April 2004 and October 2006. Of the 34 evaluable patients, none achieved a complete response (CR) and 14 achieved a partial response (PR), resulting in an overall response rate of 41.2%. The median time to progression (TTP) was 5.7 months (95% CI: 4.2~6.3 months) and the median overall survival (OS) was 9.8 months (95% CI: 4.4~12.0 months). The main hematologic toxicities were anemia and neutropenia, which were observed in 56.7% and 32.4% of the patients, respectively. Grade 3/4 neutropenia was observed in 8.1% of the patients. None of the patients experienced febrile neutropenia. Peripheral neuropathy occurred in 35.1% of the patients and all were grade 1/2. CONCLUSION: This oxaliplatin/5-FU/FA regimen showed good efficacy and an acceptable toxicity profile in elderly patients with metastatic or recurrent gastric cancer.
Aged* ; Anemia ; Drug Therapy* ; Febrile Neutropenia ; Fluorouracil* ; Humans ; Leucovorin* ; Neutropenia ; Peripheral Nervous System Diseases ; Stomach Neoplasms*

BACKGROUND: We evaluated the efficacy and toxicity of docetaxel plus cisplatin combination as first-line chemotherapy for advanced gastric cancer. METHODS: Patients with metastatic or recurrent gastric adenocarcinoma, performance score neutropenia was occurred in 7 patients (19.4%) and febrile neutropenia was observed in 6 patients (16.7%). CONCLUSION: Docetaxel plus cisplatin combination as first-line chemotherapy in patients with advanced gastric cancer was effective and tolerable.
Adenocarcinoma ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Febrile Neutropenia ; Humans ; Neutropenia ; Stomach Neoplasms*

PURPOSE: Paclitaxel (P) and gemcitabine (G) are clinically synergistic in small cell lung cancer (SCLC). We evaluated the efficacy of PG as a salvage treatment for SCLC patients whose disease progressed after a platinum-containing regimen. MATERIALS AND METHODS: Eligibility included histologically confirmed SCLC, one dimensionally measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and progressive disease after platinum-based chemotherapy. Treatment consisted of P (80 mg/m2) and G (1,000 mg/m2) on days 1 and 8 of each cycle of 21 days until disease progression. RESULTS: Thirty-three patients seen between December 2005 and February 2009 were selected into this study. Thirty patients (91%) had received irinotecan-platinum, and three had received etoposide-platinum. Sixteen patients (49%) had a treatment-free interval of less than 3 months. The overall response rate was 30.3% (29.4% in sensitive relapse and 31.3% in refractory relapse). The median time to progression was 12.0 weeks and median overall survival (OS) 31.0 weeks, with a 1-year OS rate of 30.3%. Toxicities were moderate and manageable with 18.2% grade (G) 4 neutropenia, 24.2% G3 thrombocytopenia, 6.1% G3 sensory neuropathy, and 3% G3 asthenia. One patient developed febrile neutropenia. CONCLUSION: Second-line paclitaxel and gemcitabine were well-tolerated and moderately active in SCLC patients previously treated with platinum-based chemotherapy.
Asthenia ; Disease Progression ; Drug Therapy ; Febrile Neutropenia ; Humans ; Neutropenia ; Paclitaxel* ; Recurrence ; Small Cell Lung Carcinoma* ; Thrombocytopenia

PURPOSE: We conducted a multi-center, phase II trial to evaluate the efficacy and safety of using Padexol (a paclitaxel formulation) combined with cisplatin for the patients suffering with advanced gastric adenocarcinoma. MATERIALS AND METHODS: 39 patients (median age: 60 years; males: 90%) who were diagnosed with advanced gastric cancer were enrolled from 5 hospitals. Padexol 175 mg/m2 was administered as a 3-hr infusion, and this was followed by cisplatin 75 mg/m2 as an intravenous infusion on day 1, once every 3 weeks. RESULTS: Out of these 39 patients, 34 patients were assessable for treatment efficacy and 39 patients were assessable for the toxicity. Objective responses occurred in 13 patients (33%); 1 patient (3%) had a complete response and 12 patients (31%) had partial responses. 6 patients (15%) achieved a stable disease state. The median duration of response was 7.1 months, and the median time to progression and the overall survival were 4.8 months and 6.7 months, respectively. The major treatment-related adverse events were hematologic toxicity, including WHO grade 3 or 4 neutropenia in 13 patients (33%). However, febrile neutropenia occurred in only 1 patient and the non-hematologic toxicity was usually mild. CONCLUSION: The combination of Padexol and cisplatin was found to be active and it seems to be a relatively well-tolerated regimen for the treatment of advanced gastric cancer.
Adenocarcinoma ; Cisplatin* ; Febrile Neutropenia ; Humans ; Infusions, Intravenous ; Male ; Neutropenia ; Paclitaxel ; Stomach Neoplasms* ; Treatment Outcome

PURPOSE: Doxorubicin/cyclophosphamide followed by docetaxel chemotherapy (AC-D) is an intermediate risk factor (incidence of 10%–20%) for febrile neutropenia (FN) in breast cancer. However, the reported incidence of FN while using this regimen was obtained mostly from Western breast cancer patients, with little data available from Asian patients. This study aimed to assess the incidence of FN in Korean breast cancer patients and to describe clinical variables related to FN. METHODS: From September 2010 to February 2013, data from the Yonsei Cancer Center registry of breast cancer patients who received neoadjuvant or adjuvant chemotherapy with four cycles of AC-D (60 mg/m2 doxorubicin, 600 mg/m2 cyclophosphamide every 3 weeks for four cycles followed by 75 mg/m2 or 100 mg/m2 docetaxel every 3 weeks for four cycles) were analyzed. The incidence of FN, FN associated complications, dose reduction/delays, and relative dose intensity (RDI) were investigated. RESULTS: Among the 254 patients reported to the registry, the FN incidence after AC-D chemotherapy was 29.5% (75/254), consisting of 25.2% (64/254) events during AC and 4.7% (12/254) during docetaxel chemotherapy. Dose reductions, delays, and RDI less than 85.0% during AC were observed in 16.5% (42/254), 19.5% (47/254), and 11.0% (28/254) of patients, respectively. Patients with FN events frequently experienced dose reduction/delays, which eventually led to a decreased RDI. CONCLUSION: The incidence of FN during AC-D neoadjuvant or adjuvant chemotherapy was higher than expected in Korean breast cancer patients. Whether these patients should be classified as a high-risk group for FN warrants future prospective studies.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chemotherapy-Induced Febrile Neutropenia ; Cyclophosphamide ; Doxorubicin ; Drug Therapy* ; Febrile Neutropenia* ; Female* ; Humans ; Incidence* ; Prospective Studies ; Risk Factors

PURPOSE: With the increased use of chemotherapy for non small cell lung cancer (NSCLC), a growing group of patients can now be considered for second-line chemotherapy. However, guidelines for the second line treatment remain to be developed. The objective of this study was to evaluate the efficacy and safety of the gemcitabine and vinorelbine combination therapy in patients with advanced NSCLC, pretreated with taxane and platinum based regimens. Gemcitabine has already demonstrated activity in this patient group, with the combination therapy having been reported to be well tolerated in previous phase I/II studies. MATERIALS AND METHODS: Forty two patients with advanced NSCLC (stages III/IV), having received prior taxane and platinum based chemotherapy, with an ECOG performance status (PS) 0~2, and unimpaired hematopoietic and organ function, were treated with vinorelbine, 20 mg/m2, followed by gemcitabine, 1, 000 mg/m2, both administered on days 1, 8 and 15, every 4 weeks. RESULTS: Out of the 42 patients enrolled, 41 were evaluable for their response, and all 42 for their toxicity. The patient's characteristics were as follows; median age=60 years (42~73), median PS=1 (range 0~2), a gender ratio 31: 11 males/females, with stages IIIA, IIIB and IV in 3, 14 and 25 cases. The objective responses included a partial response (PR) 8/41 (19.5%), a stable disease 15/41 (36.6%) and a progressive disease 18/41 (43.9%). The median time-to progression (TTP) and survival were 4 months, ranging from 2 to 14 months, and 8 months, ranging from 2 to 17+ months, respectively. Grade 3 neutropenia was seen in 19% of the patient, and there was no grade 4 neutropenia or episodes of febrile neutropenia. No grade 4 thrombocytopenia or other grade 3/4 non-hematological toxicities were observed. CONCLUSION: The combination of gemcitabine/vinorelbine is active and well tolerated in patients with advanced NSCLC having failed prior taxane/platinum therapy.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Febrile Neutropenia ; Humans ; Neutropenia ; Platinum ; Small Cell Lung Carcinoma ; Thrombocytopenia