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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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.

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.

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.