***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Multiplex PCR ( mPCR ) directly from blood has been suggested as a promising method for rapid identification of pathogens causing sepsis . This study aim ed to investigate whether mPCR has any impact on antimicrobial treatment . Hematological patients with febrile neutropenia were r and omized into two groups . In the study group , mPCR was performed as an addition to st and ard diagnostics , and PCR finding was immediately communicated to the clinicians , thus being available for decision making . In the control group , clinicians were not aware of PCR result . PCR sample s were collected simultaneously with clinical ly indicated blood culture specimens from peripheral vein and /or central venous catheter at fever onset and once again if fever persisted up to 72 h. Overall , 74 patients of the study group and 76 patients of the control group were enrolled and 253 sample s collected . Therapy was changed to targeted antimicrobial therapy ( AMT ) in 12 patients ( 16.2 % ) in the study group and in 12 patients ( 15.8 % ) in the control group . For patients with changes , the median time to change to the targeted AMT was 21.4 h in the study group and 47.5 h in the control group ( p = 0.018 ) . In the study group , 57.1 % ( 8/14 ) of changes to targeted AMT was due to PCR finding . PCR led to AMT change in 9.5 % ( 7/74 ) of study group patients , i.e. , in 33.3 % ( 7/21 ) of patients who had positive PCR finding . There were no significant differences in patient outcomes ( secondary endpoints ) . In conclusion , PCR method accelerates change to the targeted AMT in febrile neutropenic patients PURPOSE To prospect ively derive and vali date a clinical prediction rule to allow a more tailored approach to the management of pediatric oncology out patients presenting with fever and neutropenia . PATIENTS AND METHODS The clinical prediction rule was derived over a 1-year period and then vali date d over the following 8 months in a new set of fever and neutropenia episodes . Patients were excluded if they presented with comorbidity or an abnormal chest x-ray ( CXR ) . RESULTS Significant bacterial infection ( SBI ; defined as any blood or urine culture positive for bacteria , interstitial or lobar consolidation on CXR , or unexpected death from infection ) was documented in 43 of the 227 episodes . Multivariate analysis found four significant factors : bone marrow disease , general appearance unwell on initial examination , monocyte count less than 0.1 x 10(9)/L , and peak oral or oral equivalent temperature greater than 39 degrees C. Only the monocyte count contributed to determining a low-risk group , excluding SBI with 84 % sensitivity ( 95 % confidence interval [ CI ] , 61 % to 100 % ) , 42 % specificity ( 95 % CI , 38 % to 46 % ) , and a negative predictive value of 92 % ( 95 % CI , 76 % to 100 % ) . If the monocyte count was > /= 0.1 x 10(9)/L at the time of presentation ( low risk ) , the incidences of SBI and bacteremia were 8 % and 5 % , respectively , versus 25 % and 17 % in the high-risk group . When vali date d in a new population of 136 episodes of fever and neutropenia , the incidences of SBI and bacteremia in the low-risk group were 12 % and 5 % , respectively , and 25 % and 19 % in the high-risk group . CONCLUSION Pediatric oncology out patients with fever and neutropenia who present with an initial monocyte count of > /= 0.1 x 10(9)/L and do not have comorbidity or an abnormal CXR at the time of presentation are at lower risk for SBI and can be considered for less aggressive initial therapy To determine whether combination antibiotic therapy including a short course of an aminoglycoside was as effective and less toxic than a conventional long course of the combination for the empirical therapy of gram-negative bacteremia in patients with cancer and granulocytopenia , we conducted a r and omized multicenter trial comparing ceftazidime plus a short course ( three days ) of amikacin , ceftazidime plus a long course ( nine days ) of amikacin , and azlocillin plus a long course ( nine days ) of amikacin .  Single-organism gram-negative bacteremia occurred in 129 of 872 evaluable patients . Without a change in antibiotics , the response rates were 81 percent with ceftazidime and long-course amikacin , 48 percent with ceftazidime and short-course amikacin ( P = 0.002 ) , and 40 percent with azlocillin and long-course amikacin ( P less than 0.001 ) . Among patients with fewer than 100 granulocytes per cubic millimeter throughout therapy , the response rates were 6 percent with ceftazidime and short-course amikacin and 50 percent with ceftazidime and long-course amikacin ( P = 0.03 ) . Linear logistic-regression analysis showed that therapy with ceftazidime and long-course amikacin was the most favorable prognostic factor of the response to infection , whereas the presence of leukemia or shock was the least favorable . We conclude that ceftazidime should be given in combination with a conventional full course of an aminoglycoside ( amikacin ) when used for the empirical treatment of gram-negative bacteremia in cancer patients with granulocytopenia Abstract Early initiation of empiric antibiotic therapy in febrile cancer patients has become established practice , but the appropriate duration of antibiotic therapy when no infectious source can be identified is unknown . The complications of broad-spectrum antibiotics argue for brief treatment , but the risk of an inadequately treated infection in the granulocytopenic patient favors longer therapy . We prospect ively studied 306 episodes of fever and granulocytopenia in 143 patients with leukemia or solid tumor ( age one to 33 years ) with respect to the duration of empiric antibiotic treatment . Eligible patients ( fever > 38 ° C three times/24 hours or > 38.5 ° C once , plus polymorphonuclear leukocytes 3 ) had an extensive diagnostic evaluation , including at least two preantibiotic blood cultures , and therapy was then started with a broad-spectrum antibiotic regimen— Keflin ® , gentamicin and carbenicillin ( KGC ) . Initial evaluation failed to identify an infectious etiology for the fever in 142 of 306 ( 46 per cent ) episodes . Fifty-six of 142 ( 39 per cent ) of these fevers of unknown origin were associated with persistent granulocytopenia for more than seven days ; in 33 of these , defervescence occurred while the patients received KGC . After seven days of empiric KGC therapy , the 33 patients with fevers of unknown origin who had become afebrile with empiric antibiotics but whose polymorphonuclear leukocytes remained less than 500/mm 3 were r and omized to either continue or discontinue ( dc ) to receive KGC . The patients who continued to receive KGC until their polymorphonuclear leukocytes were more than 500/mm 3 had no infectious sequelae . However , in seven of 17 ( 41 per cent ) of the patients r and omized to dc KGC infectious sequelae developed ( p = 0.007 ) within a median of two days of discontinuing KGC ( two with fever which again responded to KGC therapy , and five with a documented infection [ two ultimately fatal ] ) . In none of the patients did a resistant microbial flora or superinfection develop . These data suggest that the patient with a fever of unknown origin who becomes afebrile during empiric antibiotic therapy may profit from continued therapy while granulocytopenia persists Plain chest roentgenograms may be normal or show nonspecific abnormalities during the frequent febrile episodes that occur in patients after bone marrow transplantation . In this group , ultrafast 10-mm and 3-mm high-resolution CT scans were prospect ively performed in 33 patients to determine if useful information was provided that either changed the patient 's clinical management or added confidence to the clinical diagnosis . The 36 symptomatic episodes that occurred in 33 patients included fever in 20 episodes and fever combined with cough , dyspnea , chest pain , or rales in 16 . Fourteen chest roentgenograms were interpreted as normal , and 22 were interpreted as demonstrating nonspecific changes ; however , none of the roentgenograms was considered helpful in that they did not provide sufficient information for further management . In 2 of 14 episodes in patients with normal chest roentgenograms and in 9 of 22 episodes in patients with nonspecific chest roentgenograms , CT scanning result ed in a change in clinical management that included performing bronchoscopy , increasing or changing antibiotic coverage , starting white blood cell transfusions , requesting surgical biopsy , or a combination of these . In 1 of 14 episodes in patients with normal chest roentgenograms and in 8 of 22 episodes in patients with nonspecific roentgenograms , CT added confidence to the diagnosis . In the remaining 16 episodes , CT scans provided no additional information . We conclude that in many instances , noncontrast ultrafast chest CT scans can provide information that may either change a patient 's clinical management or more clearly establish the extent of pulmonary disease BACKGROUND Guidelines advocate > 7d of broad-spectrum antibiotics for unexplained fever ( UF ) during neutropaenia . However , effective antimicrobial prophylaxis reduces the incidence of gram-negative infections , which may allow shorter treatment . This study evaluates the safety of discontinuing empirical broad-spectrum antibiotics if no microbial source is documented after an initial work-up of 72 h. METHODS Prospect i ve observational study at a tertiary-care haematology-unit in patients suffering from haematologic malignancies and treatment-induced prolonged neutropaenia of 10d .  Oral fluoroquinolone and fluconazole prophylaxis was given from day 1 . Fever was empirically treated with imipenem which was discontinued after 72 h if , following a st and ardised protocol , no infectious aetiology was documented . Duration of fever , antimicrobial therapy and overall mortality were registered . RESULTS One hundred and sixty six patients were evaluated during 276 neutropaenic episodes . One hundred and thirty six patients ( 82.5 % ) experienced 1 febrile episode . A total of 317 febrile episodes were observed , of which 177 ( 56 % ) were diagnosed as UF . In 135 febrile episodes ( 43 % ) , a probable/definite infectious origin was documented . Mean duration of fever in neutropaenic periods with 1 febrile episode was 5d , and mean time of treatment with imipenem was 4.7d . In patients without documented infection , mean time of imipenem treatment was only 3.7d . Overall mortality 30 d after neutrophil recovery was 3.6 % ( 6/166 ) ; no patient died from untreated bacterial infection . CONCLUSION Discontinuation of broad-spectrum antibiotics during neutropaenia in haematology patients on fluoroquinolone and fluconazole prophylaxis is safe , provided that no infectious aetiology is established after 72 Background . St and ard treatment for fever during periods of chemotherapy‐induced neutropenia includes hospitalization and administration of intravenous antibiotics until the patient is afebrile and no longer neutropenic . This study prospect ively evaluates the safety and cost‐effectiveness of early discharge of selected low risk children before recovery from neutropenia OBJECTIVES To assess the risk factors , antibiotic therapy and outcomes of multidrug-resistant Gram-negative bacilli ( MDRGNB ) bacteraemia in hospitalized patients with cancer . METHODS Episodes of MDRGNB bacteraemia were compared with a susceptible control group in a 4 year prospect i ve study . RESULTS Of 747 bacteraemias , 372 ( 49.7 % ) were caused by a Gram-negative bacilli ( GNB ) . Fifty-one of these ( 13.7 % ) were caused by a multidrug-resistant ( MDR ) strain . Previous antibiotics [ odds ratio ( OR ) 3.57 ; 95 % confidence interval ( CI ) 1.63 - 7.80 ] and urinary catheter ( OR 2.41 ; 95 % CI 1.01 - 5.74 ) were identified as independent risk factors for MDRGNB acquisition . The most frequent mechanism of resistance was extended-spectrum β-lactamase ( ESBL ) production ( 45 % ) , mainly by Escherichia coli , followed by Amp-C cephalosporinase hyperproduction ( 24 % ) . Patients with MDRGNB bacteraemia more frequently received inadequate initial antibiotic therapy ( 69 % versus 9 % ; P < 0.001 ) and time to adequate therapy was longer in this group ( 41 % versus 4 % ; P < 0.001 ) . Patients in the resistant group more frequently required intensive care unit ( ICU ) admission ( 14 % versus 5 % ; P = 0.023 ) , had greater need for mechanical ventilation ( 14 % versus 3 % ; 
    Output:
    
Results of microbiological outcomes favouring long antibiotic therapy may be misleading due to lower culture positivity rates under antibiotic therapy and not true differences in infection rates .