World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 6, Number 1, February 2015, pages 283-291

A Comparative Study of Piperacillin-Tazobactam With and Without Vancomycin as Empirical Therapy for Febrile Neutropenic Patients With Solid Tumor Malignancies

**Table 1.** Patients Demographic, Frequency of Malignancies and Outcome of Logistic Regression Analysis of PT and PT + VM therapies
Variables	PT	PT + VM	Odds ratio (Exp(B))	95% CI	X² stat (df)	P value (Wald)
NC: not computed; PT: piperacillin-tazobactam; VM: vancomycin.
Age, median (range)	49.11 (51)	58.11 (58)	53.45 (47)	47.45 (65)	0.997	0.964 - 1.030	0.040 (1)	0.841
Sex, gender	35 (58.33%)	25 (41.67%)	16	10	1.143	0.445 - 2.932	0.077 (1)	0.781
Malignancy type
Colorectal Ca	11 (55%)	9 (45%)	3 (60%)	2 (40%)	Nil	Nil	26.874 (14)	0.841
Breast Ca	18 (100%)	0	4 (100%)	0
Ca pancreas	1 (20%)	4 (80%)	0	1 (100%)
Lung Ca	0	4 (100%)	1 (50%)	1 (50%)
Sarcoma	1 (33.3%)	2 (66.7%)	3 (75%)	1 (25%)
Gallbladder Ca	1 (50%)	1 (50%)	0	0
Malignant of bile duct	0	1 (100%)	0	0
Esophagus Ca	0	1 (100%)	0	1 (100%)
Ovarian Ca	1 (100%)	0	1 (100%)	0
Prostate Ca	0	2 (100%)	0	0
Squamous cell Ca	1 (100%)	0	0	0
Testicular Ca	0	1 (100%)	0	3 (100%)
Nasopharynx	0	0	1 (50%)	1 (50%)
Uterus Ca	0	0	3 (100%)	0
Chemotherapy					9.818	2.127 - 45.321	13.258 (1)	0.003
< 12 days	21 (63.6%)	12 (36.4%)	15 (62.5%)	9 (37.5%)
> 12 days	14 (51.9%)	13 (48.1%)	1 (50%)	1 (50%)
Success					0.000	0.000 - 0.000	0.725 (1)	1.000
< 7 days	35 (59.3%)	24 (40.7%)	16 (59.3%)	10 (38.5%)
> 7 days	Nil	1 (100%)	Nil	Nil
Mortality (within sex)					NC	NC	NC	NC
Yes	Nil	Nil	Nil	Nil
No	35 (100%)	25 (100%)	16 (100%)	10 (100%)

Table 1. Patients Demographic, Frequency of Malignancies and Outcome of Logistic Regression Analysis of PT and PT + VM therapies

Variables

PT + VM

Odds ratio (Exp(B))

95% CI

X² stat (df)

P value (Wald)

Female

Male

Female

Male

NC: not computed; PT: piperacillin-tazobactam; VM: vancomycin.

Age, median (range)

49.11 (51)

58.11 (58)

53.45 (47)

47.45 (65)

0.997

0.964 - 1.030

0.040 (1)

0.841

Sex, gender

35 (58.33%)

25 (41.67%)

1.143

0.445 - 2.932

0.077 (1)

0.781

Malignancy type

Colorectal Ca

11 (55%)

9 (45%)

3 (60%)

2 (40%)

Nil

26.874 (14)

0.841

Breast Ca

18 (100%)

4 (100%)

Ca pancreas

1 (20%)

4 (80%)

1 (100%)

Lung Ca

4 (100%)

1 (50%)

Sarcoma

1 (33.3%)

2 (66.7%)

3 (75%)

1 (25%)

Gallbladder Ca

1 (50%)

Malignant of bile duct

1 (100%)

Esophagus Ca

1 (100%)

Ovarian Ca

1 (100%)

Prostate Ca

2 (100%)

Squamous cell Ca

1 (100%)

Testicular Ca

1 (100%)

3 (100%)

Nasopharynx

1 (50%)

Uterus Ca

3 (100%)

Chemotherapy

9.818

2.127 - 45.321

13.258 (1)

0.003

< 12 days

21 (63.6%)

12 (36.4%)

15 (62.5%)

9 (37.5%)

> 12 days

14 (51.9%)

13 (48.1%)

1 (50%)

Success

0.000

0.000 - 0.000

0.725 (1)

1.000

< 7 days

35 (59.3%)

24 (40.7%)

16 (59.3%)

10 (38.5%)

> 7 days

Nil

1 (100%)

Nil

Mortality (within sex)

Yes

Nil

35 (100%)

25 (100%)

16 (100%)

10 (100%)

**Table 2.** Response to Therapy of PT Versus PT + VM Treatment Groups
Effectiveness variables	Baseline	PT	PT + VM	Odds ratio	95% CI	X² stat (df)	P value
Fever	< 38.1 °C	35 (58.3%)	25 (41.7%)	16 (61.5%)	10 (38.5%)	NC	NC	NC	NC
> 38.1 °C	Nil	Nil	Nil	Nil
Pleural effusion	Yes	9 (56.2%)	7 (43.8%)	3 (50%)	3 (50%)	0.825	0.281 - 2.422	0.124 (1)	0.726
No	26 (59.1%)	18 (40.9%)	13 (65%)	7 (35%)
Consolidation	Yes	5 (14.3%)	4 (16%)	4 (25%)	3 (30%)	2.088	0.682 - 6.395	1.621 (1)	0.197
No	30 (58.8%)	21 (41.2%)	12 (63.2%)	7 (36.8%)

Table 2. Response to Therapy of PT Versus PT + VM Treatment Groups

Effectiveness variables

Baseline

PT + VM

Odds ratio

95% CI

X² stat (df)

P value

Frequency (F)

Frequency (M)

Frequency (F)

Frequency (M)

Fever

< 38.1 °C

35 (58.3%)

25 (41.7%)

16 (61.5%)

10 (38.5%)

> 38.1 °C

Nil

Pleural effusion

Yes

9 (56.2%)

7 (43.8%)

3 (50%)

0.825

0.281 - 2.422

0.124 (1)

0.726

26 (59.1%)

18 (40.9%)

13 (65%)

7 (35%)

Consolidation

Yes

5 (14.3%)

4 (16%)

4 (25%)

3 (30%)

2.088

0.682 - 6.395

1.621 (1)

0.197

30 (58.8%)

21 (41.2%)

12 (63.2%)

7 (36.8%)

**Table 3.** Overall Outcome of PT Versus PT + VM Therapies
Outcome variables	Gender	PT	PT + VM	X² stat (df)	P value
Duration of fever (days), median (range)	F	2 (5)	40.93	2 (5)	49.42	0.012 (1)	0.114
M	1 (6)	2 (3)
Duration of neutropenia (days), median (range)	F	4 (10)	38.74	6 (5)	54.48	7.387 (1)	0.007
M	7 (13)	7.5 (6)
Length of stay (day), median (range)	F	7 (49)	44.85	8 (55)	40.38	0.583 (1)	0.445
M	13 (38)	7.5 (22)
Duration of therapy (days), median (range)	F	6 (13)	43.69	PT: 6 (7) VM: 5 (12)	43.06/13.50	0.012 (1)	0.913
M	7 (13)	PT: 6 (11) VM: 3 (10)

Table 3. Overall Outcome of PT Versus PT + VM Therapies

Outcome variables

Gender

PT + VM

X² stat (df)

P value

Duration (median)

Mean rank

Duration (median)

Mean rank

Duration of fever (days), median (range)

2 (5)

40.93

2 (5)

49.42

0.012 (1)

0.114

1 (6)

2 (3)

Duration of neutropenia (days), median (range)

4 (10)

38.74

6 (5)

54.48

7.387 (1)

0.007

7 (13)

7.5 (6)

Length of stay (day), median (range)

7 (49)

44.85

8 (55)

40.38

0.583 (1)

0.445

13 (38)

7.5 (22)

Duration of therapy (days), median (range)

6 (13)

43.69

PT: 6 (7)
VM: 5 (12)

43.06/13.50

0.012 (1)

0.913

7 (13)

PT: 6 (11)
VM: 3 (10)

**Table 4.** Bacterial Spectrum, Susceptibility and Resistance Patterns of Microorganisms
Organisms	Number of isolates	%	PT	VM	OC
Gram-positive organisms
Staphylococcus aureus	7	35%	-	-	100	0	71.48	28.52
Streptococcus spp	7	35%	-	-	100	0	69.55	30.45
Corynebacterium spp	3	15%	-	-	-	-	-	-
Enterococcus spp	2	10%	-	-	98.85	1.15	Nil	Nil
Staphylococcus spp	1	5%	-	-	99.8	0.2	13.73	86.27
Gram-negative organisms
Escherichia coli	18	60%	79.92	20.08	-	-	-	-
Klebsiella pneumoniae	4	13.33%	69.23	30.77	-	-	-	-
Pseudomonas spp	3	10%	83.23	16.77	-	-	-	-
Aeromonas hydrophylia	1	3.33%	-	-	-	-	-	-
Stenotropomonas multipholia	1	3.33%	-	-	-	-	-	-
Serratia marcescens	1	3.33%	93.66	6.34	-	-	-	-
Providencia stuartii	1	3.33%	-	-	-	-	-	-
Enterobacter spp	1	3.33%	67.41	32.59	-	-	-	-

Table 4. Bacterial Spectrum, Susceptibility and Resistance Patterns of Microorganisms

Organisms

Number of isolates

S %

R %

S %

R %

S %

R %

Gram-positive organisms

Staphylococcus aureus

35%

100

71.48

28.52

Streptococcus spp

35%

100

69.55

30.45

Corynebacterium spp

15%

Enterococcus spp

10%

98.85

1.15

Nil

Staphylococcus spp

99.8

0.2

13.73

86.27

Gram-negative organisms

Escherichia coli

60%

79.92

20.08

Klebsiella pneumoniae

13.33%

69.23

30.77

Pseudomonas spp

10%

83.23

16.77

Aeromonas hydrophylia

3.33%

Stenotropomonas multipholia

3.33%

Serratia marcescens

3.33%

93.66

6.34

Providencia stuartii

3.33%

Enterobacter spp

3.33%

67.41

32.59

**Table 5.** Logistic Regression Analysis of Variables Associated With Treatment Success Without Treatment Modification
Variables	Univariate OR (95% CI)	Univariate (P)	Multivariate OR (95% CI)	Multivariate (P)
ALP: alkaline phasphatase; AST: aspartate aminotransferase; GGT: gama-glutamyl transepiptidase.
Chemotherapy, < 12 days vs. > 12 days	9.818 (2.127 - 45.32)	0.003	3.442 (1.29 - 754.09)	0.034
Lung consolidation, yes vs. no	2.088 (0.682 - 6.395)	0.197	2.305 (1.323 - 75.003)	0.026
Blood pressure, baseline: 90/60 to 130/90 mm Hg vs. < 80/50 and > 200/120 mm Hg	0.078 (0.024 - 0.258)	0.001	-3.094 (0.005 - 0.386)	0.005
WBC, baseline: 4.5 - 11 × 10⁹/L vs. < 4.5 - 11 × 10⁹/L	0.233 (0.084 - 0.652)	0.005	-1.923 (0.021 - 1.01)	0.051
Hemoglobin, baseline: 13.5 - 17.5 g/dL vs. < 13.5 - 17.5 g/dL	0.146 (0.053 - 0.404)	0.001	-2.628 (0.011 - 0.477)	0.006
Blood urea nitrogen, baseline: 2.7 - 7.2 mmol vs. < 2.7 - > 7.2 mmol	0.267 (0.102 - 0.700)	0.007	-1.343 (0.049 - 1.382)	0.114
Serum creatinine level, baseline: F, 47 - 115/M, 53 - 88 mmol/L vs. > 47 - 115/M, > 53 - 88 mmol	3.319 (0.692 - 15.919)	0.134	-0.173 (0.046 - 15.466)	0.907
ALP, baseline: 54 - 144 mmol/L vs. > 144 mmol/L	5.111 (1.380 - 18.929)	0.015	2363 (0.571 - 193.476)	0.113
AST, baseline: 8 - 38 U/L vs. > 38 U/L	6.25 (0.768 - 50.860)	0.087	1.546 (0.051 - 432.207)	0.503
GGT, baseline: 15 - 85 U/L vs. > 85 U/L	2.539 (0.931 - 6.928)	0.069	0.422 (0.14 - 16.174)	0.726

Table 5. Logistic Regression Analysis of Variables Associated With Treatment Success Without Treatment Modification

Variables

Univariate OR (95% CI)

Univariate (P)

Multivariate OR (95% CI)

Multivariate (P)

ALP: alkaline phasphatase; AST: aspartate aminotransferase; GGT: gama-glutamyl transepiptidase.

Chemotherapy, < 12 days vs. > 12 days

9.818 (2.127 - 45.32)

0.003

3.442 (1.29 - 754.09)

0.034

Lung consolidation, yes vs. no

2.088 (0.682 - 6.395)

0.197

2.305 (1.323 - 75.003)

0.026

Blood pressure, baseline: 90/60 to 130/90 mm Hg vs. < 80/50 and > 200/120 mm Hg

0.078 (0.024 - 0.258)

0.001

-3.094 (0.005 - 0.386)

0.005

WBC, baseline: 4.5 - 11 × 10⁹/L vs. < 4.5 - 11 × 10⁹/L

0.233 (0.084 - 0.652)

0.005

-1.923 (0.021 - 1.01)

0.051

Hemoglobin, baseline: 13.5 - 17.5 g/dL vs. < 13.5 - 17.5 g/dL

0.146 (0.053 - 0.404)

0.001

-2.628 (0.011 - 0.477)

0.006

Blood urea nitrogen, baseline: 2.7 - 7.2 mmol vs. < 2.7 - > 7.2 mmol

0.267 (0.102 - 0.700)

0.007

-1.343 (0.049 - 1.382)

0.114

Serum creatinine level, baseline: F, 47 - 115/M, 53 - 88 mmol/L vs. > 47 - 115/M, > 53 - 88 mmol

3.319 (0.692 - 15.919)

0.134

-0.173 (0.046 - 15.466)

0.907

ALP, baseline: 54 - 144 mmol/L vs. > 144 mmol/L

5.111 (1.380 - 18.929)

0.015

2363 (0.571 - 193.476)

0.113

AST, baseline: 8 - 38 U/L vs. > 38 U/L

6.25 (0.768 - 50.860)

0.087

1.546 (0.051 - 432.207)

0.503

GGT, baseline: 15 - 85 U/L vs. > 85 U/L

2.539 (0.931 - 6.928)

0.069

0.422 (0.14 - 16.174)

0.726