The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic (< 1000/mm3) patients with liquids and solid tumours. Of 30 evaluable episodes, 15 were treated with imipenem-cilastatin and 15 were treated with sulbactam-cefoperazone plus amikacin. 73% of episodes were culture-positive: gram-positive pathogens accounted for 62% of the isolates. Bacteremia was the most frequent site of infection. The initial clinical response rate for both regimens was 60% (p > 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Amikacin/therapeutic use ; Antibiotics, Combined/therapeutic use* ; Bacteremia/drug therapy ; Bacteremia/complications ; Cefoperazone/therapeutic use ; Cilastatin/therapeutic use ; Female ; Fever/drug therapy* ; Fever/complications ; Human ; Imipenem/therapeutic use ; Male ; Middle Age ; Neoplasms/drug therapy* ; Neoplasms/complications ; Neutropenia/drug therapy* ; Neutropenia/complications ; Prospective Studies ; Sulbactam/therapeutic use

BACKGROUND:Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, findings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8％) males and 168 (41.2％) females with a median age of 57.9 years (range 19–87). Regarding cancer staging, 266 patients (65.3％) had metastatic disease and 142 (34.7％) had local and loco-regional disease. The hospitalization rate was 59.6％. The most common symptoms were shortness of breath (23.2％), pain (17.8％), fever (14.2％), and nausea/vomiting (14.4％). The most common cancer sites were the lung (32.5％), gastrointestinal system (25.4％), and breast (9.3％). The initial evaluation determined progressive disease (42.4％), chemotherapy effects (20.7％), infections (17.2％), radiotherapy effects (4.7％), extravasation (1.8％), anemia (1.4％), and unknown (11.3％). During follow up, 191 (46.8％) patients died after admission to the ED. The 1-year overallsurvival of allpatients was 7.3 months. CONCLUSIONS:Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.