Rinku General Medical Center

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1 Rinku General Medical Center

2 Ann Intern Med. 1966; 64: CHOP J Clin Oncol. 1998; 16:

3 Febrile Neutropenia IDSA(Infectious Diseases Society of America) 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer

4 a 60 b 21 a 1 b /mm3 X J Clin Oncol 2000 ; 28 : FN N72 N13 N20 N26 N13 11(855(2520(779(69 2(156(30 5(194(31 0 a 9(45 b 1(40 c a

5 (%) () MSSA ND MRSA NF-GNR A (35) 12(39) 8(26) B (59) 8(24) 6(18) C (66) 9(17) 9(17) D (68) 12(19) 8(13) Total

6 or or or or or + (38.3) 1 (500/mm 3 ) 2 IDSA(Infectious Diseases Society of America) 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer ~5

7 3~5 ( ) IDSA(Infectious Diseases Society of America) 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer 500/ / 23 3~5 3~5 B 5~7 IDSA(Infectious Diseases Society of America) 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer

8 Randomized Trial of CFPM Monotherapy or CFPM in Combination with AMK as Empirical Therapy for FN. Clin Infect Dis. 2004; 39:S15 24 Table 5. Clinical response according to baseline neutrophil count among pts in the 2 treatment arms. No (%) of patients with response, by day after initiation of therapy and baseline neutrophil count Day 3 Day 7 Treatment arm, outcome CFPM Effective Not effective Subtotal CFPM+AMK Effective Not effective Subtotal All patients Effective Not effective Subtotal 500 cells/l 21 (27.6)a 21 ( 55 (72.4) 76 (100) 36 (45.0)e 36 ( 44 (55.0) 80 (100) 57 (36.5) 99 (63.5) 156 (100) 500 cells/l 10 (52.6)b 10 ( 9 (47.4) 19 (100) 7 (50.0)f 7 (50.0) 14 (100) 17 (51.5) 16 (48.5) 33 (100) Subtotal 31 (32.6) 64 (67.4) 95 (100) 43 (45.7) 51 (54.3) 94 (100) 74 (39.2) 115 (60.8) 189 (100) P values are as follows: a vs. b, P=0.038 ; a vs. e, P= cells/l 48 (63.2)c 28 (36.8) 76 (100) 60 (75.0)g 20 (25.0) 80 (100) 108 (70.1) 48 (29.9) 156 (100) 500 cells/l 13 (68.4)d 6 (31.6) 19 (100) 12 (85.7)h 2 (14.3) 14 (100) 25 (75.8) 8 (24.2) 33 (100) Subtotal 61 (64.2) 34 (35.8) 95 (100) 72 (76.6) 22 (23.4) 94 (100) 133 (78.8) 56 (21.2) 189 (100)

9 / 1 or 33 or Clinical Infectious Diseases 2004:39 (Supple1)

10 -D Clinical Infectious Diseases 2004:39; Clinical Infectious Diseases 2004:39;

11 ELISA) British Journal of Haematology :126: British Journal of Haematology :126:

12 B Clin Infect Dis. 2004; 39:S38 43

13 EX DNR VCR PSL L-Asp WBC / Blast 経過 1 Imatinib G-CSF Neutropenic fever CHF IPA (9/11) (9/24) (10/4) (10/9) (10/13) 肺アスペルギルス症 ( 画像 )

14 (WBC) AMPH-B 経過 2 Imatinib MCFG IPA (CRP) (10/15) (11/13) (12/10) (2/21) (3/12)

15 Rate,% OR(95% CI) P 3.47( ) ( ) 2.47( ) 1.59( ) 2.03( ) ( ) ( ) Rate,% OR(95% CI) P ( ) ( ) 3.47( ) ( ) 5.12( ) 2.09( ) 0.87( )

16 )

17

18

19

20 Clin Infect Dis. 2004; 39:S25 31

21

22 Clin Infect Dis. 1996; 23:

23 pg/ml

24 Rev Infect Dis Nov-Dec;12(6): retrospective / Clin Infect Dis May;26(5):

25 -12Hr 0

26 ClinicalCourse British Journal of Haematology 2004 :127:

27 British Journal of Haematology 2004 :127: Oncology Nursing Forum, 2004 ; 31: 4:

28

29 +

30 ESHAP 300mg 200mg~400mg 3g NSAIDS

特殊病態下感染症における抗菌薬治験の手引き作成委員会報告書(案)

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