P. A. Pizzo

Journal Article From the Infectious Diseases Society of America: Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Unexplained Fever Get access Walter T. Hughes, Chairman, Walter T. Hughes, Chairman Working Committee, Infectious Diseases Society of America Reprints and correspondence: Dr. Walter T. Hughes, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38101. Search for other works by this author on: Oxford Academic PubMed Google Scholar Donald Armstrong, Donald Armstrong Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Gerald R Bodey, Gerald R Bodey Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Ronald Feld, Ronald Feld Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Gerald L. Mandell, Gerald L. Mandell Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Joel D. Meyers, Joel D. Meyers Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Philip A. Pizzo, Philip A. Pizzo Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Stephen C. Schimpff, Stephen C. Schimpff Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Jerry L. Shenep, Jerry L. Shenep Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar James C. Wade, James C. Wade Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Lowell S. Young, Lowell S. Young Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar Martha D. Yow Martha D. Yow Working Committee, Infectious Diseases Society of America Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 161, Issue 3, March 1990, Pages 381–396, https://doi.org/10.1093/infdis/161.3.381 Published: 01 March 1990 Article history Received: 14 August 1989 Revision received: 26 October 1989 Published: 01 March 1990

EDITOR-Our article [1] referred to by Kalman and Barriere [2] is a consensus report and not a literature review.However, an in-depth study of the world literature was undertaken and an effort was made to base our conclusions on published scientific data when possible, attempting to avoid certain pitfalls.Individual biases of committee members were guarded against, and recommendations based on anecdotal experiences and selected unilateral literature references were discouraged.The most treacherous pitfall was misinterpretation of published research on the use of antibiotics in granulocytopenic patients with fever.Such factors as experimental design, criteria for enrollment, definitions of therapeutic success and failure, and critical analysis of data vary greatly from study to study, often not permitting valid comparison of studies with the same drug or drug combinations.An important companion paper to the consensus report in the same issue of the Journal [3] provides guidelines for more uniform and valid clinical trials.We believe Kalman and Barriere have experienced the above pitfalls.They recommend that physicians "avoid the use of double {3-lactams whenever possible" and support the statement with selected references dealing with only the negative aspects of the combination, and they have misinterpreted some of the published articles.In the committee's report we acknowledged the disadvantages of {3-lactam combinations including the occasional emergence of resistant organisms, high cost, possible antagonism with certain bacterial infections, and possible limited effects against staphylococci, enterococci, and anaerobic bacteria.We commented on the first European Organization for Research on Treatment of Cancer (EORfC) study [4], which demonstrated the greater efficacy of {3lactam plus aminoglycosides than of two {3-lactams, but we also pointed out that the {3-lactams (cephalothin and carbenicillin) used in this 1978 study are obsolete and not comparable to more modern {3-lactams in current use.The fourth EORTC study [5] is not a study of double {3-lactams; it compares single {3-lactams with amikacin and is not relevant to the argument.The study by Winston et al. [6] is misinterpreted by Kalman and Barriere.This prospective randomized study of 212 patients at the University of California Los Angeles (UCLA) showed the overall therapeutic response rates for moxolactam plus piperacillin (77 %) and moxolactam plus amikacin (79 %) were similar.There was no difference in toxicity.Furthermore, Kalman and Barriere did not mention a more recent study of 243 febrile granulocytopenic patients, also at UCLA, treated with piperacillin plus cefoperazone [7].The authors concluded that the combination "provides adequate coverage for most bacterial pathogens and is safe and effective therapy for febrile granulocytopenic patients:' These studies were influential in the committee's decision to include a statement on double {3-lactams in the report.It is therefore surprising that an argument against double {3-lactams comes from the same center where the combination was found successful.

Journal Article From the Immunocompromised Host Society: The Design, Analysis, and Reporting of Clinical Trials on the Empirical Antibiotic Management of the Neutropenic Patient: Report of a Consensus Panel Get access Philip A. Pizzo, Philip A. Pizzo Immunocompromised Host Society Reprintsand correspondence:Dr. P.A. Pizzo, Pediatric Branch, National Cancer Institute, Bldg. 10, Room 13N240, Bethesda, MD 20892. Search for other works by this author on: Oxford Academic PubMed Google Scholar Donald Armstrong, Donald Armstrong Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Gerald Bodey, Gerald Bodey Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Ben de Pauw, Ben de Pauw Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Ronald Feld, Ronald Feld Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael Glauser, Michael Glauser Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Harold Gaya, Harold Gaya Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Judith Karp, Judith Karp Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Jean Klastersky, Jean Klastersky Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Giuseppi Todeschini, Giuseppi Todeschini Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Jan Verhoef, Jan Verhoef Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar James Wade, James Wade Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Lowell S. Young, Lowell S. Young Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar Jack Remington Jack Remington Immunocompromised Host Society Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 161, Issue 3, March 1990, Pages 397–401, https://doi.org/10.1093/infdis/161.3.397 Published: 01 March 1990 Article history Received: 29 June 1989 Revision received: 26 September 1989 Published: 01 March 1990

Patients with chemotherapy-induced granulocytopenia for neoplastic diseases and those receiving cyclosporin A plus corticosteroids for prevention and treatment of organ transplant rejection are two immunologically distinct patient populations with high risks for development of invasive pulmonary aspergillosis. In order to compare the pathogenesis of aspergillosis in these two high-risk populations and to further characterize the role of cyclosporin A in development of pulmonary aspergillosis, we studied the patterns of infection and inflammation in two clinically applicable rabbit models of invasive pulmonary aspergillosis. There were striking differences in the patterns of infection and inflammation of invasive pulmonary aspergillosis according to the type of underlying immune defect. Among rabbits challenged with the same intratracheal inoculum, there was a 100% mortality for invasive pulmonary aspergillosis in profoundly granulocytopenic rabbits in comparison with a 100% mortality for invasive pulmonary aspergillosis in profoundly granulocytopenic rabbits in comparison with a 100% survival in rabbits immunosuppressed with cyclosporin A plus methylprednisolone (CsA+MP). Lesions of pulmonary aspergillosis in granulocytopenic rabbits consisted predominantly of coagulative necrosis, intraalveolar hemorrhage, and scant mononuclear inflammatory infiltrate. By comparison, pulmonary foci in rabbits immunosuppressed by CsA+MP consisted mainly of neutrophilic and monocytic infiltrates, inflammatory necrosis, and scant intraalveolar hemorrhage. There was extensive infiltration by hyphae with angioinvasion in granulocytopenic rabbits, whereas conidia in various stages of germination predominated in CsA+MP treated animals in which there was a paucity of hyphae or angioinvasion. Extrapulmonary disease predominated in granulocytopenic rabbits. Methylprednisolone was the major immunosuppressive drug in rabbits treated with CsA+MP. Cyclosporin A alone did not increase the progression of pulmonary aspergillosis and did so only when used chronically with methylprednisolone.

PURPOSE: To compare the frequency of infectious episodes or other problems occurring with an externalized catheter (Hickman) versus a subcutaneously implanted device (Port-a-Cath, Pharmacia, Piscataway, NJ) in cancer patients, we performed a prospective, randomized study in 100 cancer patients (age range, 5 to 74 years). PATIENTS AND METHODS: Patients who were chemotherapy candidates and required an indwelling catheter were monitored prospectively and evaluated during the 180 days after the insertion of the catheter and again at time of study closure. The frequency of catheter use, reason for access, and any problems that might have been related to catheter use were noted. All data were collected prospectively and included the patient's age, sex, underlying malignancy, temperature, and leukocyte and absolute granulocyte counts at the time of catheter insertion and when complications occurred. The time to and reason for removal of the catheter, as well as any intercurrent infectious or mechanical problems, were also determined. RESULTS: Most of the infections that occurred were caused by gram-positive organisms, especially staphylococci or streptococci. A total of 22 complications (11 in each group) resulted in removal of the central line. Only one infection in the Hickman catheter group and four in the Port-a-Cath group led to removal of the central line. All other infectious episodes were successfully treated without removal of the catheters. The mean device life was 230 days for the Hickman catheter and 318 days for the Port-a-Cath (not significant). CONCLUSION: There were no differences between the two study groups regarding incidence of documented infections or mechanical or thrombotic complications.