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The role and optimal timing of flexible bronchoscopy and broncho-alveolar lavage chemokine measurement in severely immunocompromised febrile neutropenic patients.Liew, Chien-Li January 2009 (has links)
Respiratory infection remains a leading cause of morbidity and death in severely immunocompromised febrile neutropenic haematology patients, despite the introduction of numerous prophylactic strategies and advances in diagnosis and treatment. Prognosis is improved if an organism can be isolated and specific therapy commenced as soon as possible. Current practice in this population group is to commence empirical antibiotics and perform flexible bronchoscopy (FB) if temperature does not settle or after patients develop clinical or radiological features suggesting a respiratory source. This delay may result in a lower procedural diagnostic yield due to prior or prolonged anti-microbial treatment, and increased risk of respiratory compromise and procedural complications due to advanced respiratory infections. We hypothesised that proceeding to FB as early as possible after developing febrile neutropenia would improve treatment outcomes. With this randomised, prospective trial, we aim to further define the role of FB with reference to optimal timing of the procedure and its impact on diagnostic yield, future management and complication rate. We also aim to analyse the impact of proven infection on the cytokine profile of immunocompromised patients. Methods: Patients with acute leukaemia, allogeneic bone marrow transplantation or chronic lymphocytic leukaemia (CLL) being treated with Fludarabine/ Mabthera without an obvious non-respiratory source of infection were prospectively randomised into early bronchoscopy or conventional management groups at onset of febrile neutropenia. Bronchoalveolar lavage (BAL) fluid chemokine levels (IP-10, RANTES, MIG, IL-8, MCP-1) were measured using a human Chemokine cytometric bead array (CBA) kit. Results: Thirty-one episodes of febrile neutropenia in 29 patients were analysed; 17 conventional and 14 early. There was an increased yield in fungal growth in the early bronchoscopy group, which was not predicted by prior clinical or radiological changes. However, this had no impact on clinical management in the short-term due to the delayed growth. Overall diagnostic yield was not significantly different between the two groups. Procedural complication rate was negligible overall and there was no difference associated with either group. IP-10 and MIG were significantly lower in those patients who had a fungal pathogen isolated, compared with those study patients who did not (175.17 vs 1157.8, p=0.03, 30.33 vs 247.8, p=0.03 respectively). IP-10 levels were higher in the conventional than early group (1253.0 vs 261.14, p = 0.035) and the study population had higher MCP-1 (734 vs 2.83, p=0.006) and IL-8 levels (606.9 vs 14.25, p=0.00655) than normal controls. Those cases with fungal infection had higher mean MCP-1, RANTES and IL-8 levels than in normal controls (844.0 vs 2.83, p=0.007; 17.5 vs 2.1, p=0.03; 156.0 vs 14.25, p=0.004). Conclusions: Early bronchoscopy as a component of the septic screen in febrile neutropenic patients was feasible and safe. A significant difference in fungal yield was seen in the early bronchoscopy group compared to conventional methods, with a negligible complication rate, but this did not result in a change in immediate clinical management or outcomes. / Thesis (M.Clin.Sc.) - University of Adelaide, School of Medicine, 2009
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Incidence and Treatment of Vancomycin-Resistant Enterococci (VRE) Infection in VRE Colonized Febrile Neutropenic PatientsBossaer, John B. 01 May 2008 (has links)
No description available.
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Implementation of hazard analysis and critical control point (HACCP) system in a food service unit serving immuno-suppressed patient diets / E.E. VermeulenVermeulen, Emma Emmerenza January 2006 (has links)
Main aim: To supply recommendations to implement a Hazard Analysis of
Critical Control Points (HACCP) system in a hospital food service unit serving
low bacterial diets in order to prevent or decrease the infection rates in
Hematopoietic Stem Cell Transplant (HSCT) patients.
Objectives: Firstly, to investigate the current food safety and hygiene
status in a hospital food service unit, serving low bacterial diets, by means of
a questionnaire and bacterial swabs taken from the food service unit.
Secondly, to utilize the gathered information in a structured action plan to
implement HACCP standards successfully in the appointed food service unit.
The implementation of HACCP will not be done by the author.
Design: The primary research was done in a food service unit of a 350
bed private hospital. One unsuspected audit with a pre-designed audit form
was done. The audit consisted out of ten categories. A percentage was
allocated to each category. Four swabs, as well as four food samples, were
taken during the audit. The swabs and samples were tested to assess the
microbiological safety of the foods prepared in the appointed hospital food
service unit. The results of the audit, swabs and food samples were used to
evaluate the current Food and Safety System of the hospital food service unit
according to internationally approved HACCP standards.
Setting: The study was conducted in the metropolitan area of Gauteng,
South Africa.
Results: None of the ten areas audited was of an acceptable standard
and an average of 37% was scored. Category 5, the service and distribution
area, scored the highest (69%) and category 10, the quality procedures and
records division, scored the lowest (6%). According to United States Food
and Drug Administration Baseline Report five forbidden policies could lead to
increased risk of food borne illnesses. All five forbidden policies were
detected in the food service unit during the audit. The microbiological tests
showed relatively high microbial counts.
Conclusion: The results of the study confirmed that instead of focusing
mainly on the selection of food items allowed, and the cooking methods used
in HSCT diets, the type of food service, together with the food and safety
protocol that the food service follows, could play an important role in providing
food that is safe for HSCT patient use. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2007.
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Home Health Care of Patients With Febrile NeutropeniaBossaer, John B., Cluck, David 27 February 2013 (has links)
Febrile neutropenia is a potentially life-threatening oncologic emergency characterized by a dangerously low neutrophil count that places the patient at great risk. In these patients, fever may be the only sign of infection, which requires prompt treatment. With the increasing focus in shifting health care from inpatient centers to outpatient arenas, home health care clinicians will likely have an increased role in the care of neutropenic fever patients in the future. The article describes both the pharmacologic treatment and nonpharmacologic support required of these patients with particular attention to treatment that may be required in the patient?s home.
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Implementation of hazard analysis and critical control point (HACCP) system in a food service unit serving immuno-suppressed patient diets / E.E. VermeulenVermeulen, Emma Emmerenza January 2006 (has links)
Main aim: To supply recommendations to implement a Hazard Analysis of
Critical Control Points (HACCP) system in a hospital food service unit serving
low bacterial diets in order to prevent or decrease the infection rates in
Hematopoietic Stem Cell Transplant (HSCT) patients.
Objectives: Firstly, to investigate the current food safety and hygiene
status in a hospital food service unit, serving low bacterial diets, by means of
a questionnaire and bacterial swabs taken from the food service unit.
Secondly, to utilize the gathered information in a structured action plan to
implement HACCP standards successfully in the appointed food service unit.
The implementation of HACCP will not be done by the author.
Design: The primary research was done in a food service unit of a 350
bed private hospital. One unsuspected audit with a pre-designed audit form
was done. The audit consisted out of ten categories. A percentage was
allocated to each category. Four swabs, as well as four food samples, were
taken during the audit. The swabs and samples were tested to assess the
microbiological safety of the foods prepared in the appointed hospital food
service unit. The results of the audit, swabs and food samples were used to
evaluate the current Food and Safety System of the hospital food service unit
according to internationally approved HACCP standards.
Setting: The study was conducted in the metropolitan area of Gauteng,
South Africa.
Results: None of the ten areas audited was of an acceptable standard
and an average of 37% was scored. Category 5, the service and distribution
area, scored the highest (69%) and category 10, the quality procedures and
records division, scored the lowest (6%). According to United States Food
and Drug Administration Baseline Report five forbidden policies could lead to
increased risk of food borne illnesses. All five forbidden policies were
detected in the food service unit during the audit. The microbiological tests
showed relatively high microbial counts.
Conclusion: The results of the study confirmed that instead of focusing
mainly on the selection of food items allowed, and the cooking methods used
in HSCT diets, the type of food service, together with the food and safety
protocol that the food service follows, could play an important role in providing
food that is safe for HSCT patient use. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2007.
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