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A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand

Cheng, Allen C., Limmathurotsakul, Direk, Chierakul, Wirongrong, Getchalarat, Nongluk, Wuthiekanun, Vanaporn, Stephens, Dianne P., Day, Nicholas P. J., White, Nicholas J., Chaowagul, Wipada, Currie, Bart J. and Peacock, Sharon J. (2007). A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. Clinical Infectious Diseases,45(3):308-314.

Document type: Journal Article
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IRMA ID 10139xPUB83
Title A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand
Author Cheng, Allen C.
Limmathurotsakul, Direk
Chierakul, Wirongrong
Getchalarat, Nongluk
Wuthiekanun, Vanaporn
Stephens, Dianne P.
Day, Nicholas P. J.
White, Nicholas J.
Chaowagul, Wipada
Currie, Bart J.
Peacock, Sharon J.
Journal Name Clinical Infectious Diseases
Publication Date 2007
Volume Number 45
Issue Number 3
ISSN 1058-4838   (check CDU catalogue open catalogue search in new window)
Start Page 308
End Page 314
Total Pages 7
Place of Publication US
Publisher University of Chicago Press
Field of Research 1103 - Clinical Sciences
1108 - Medical Microbiology
0605 - Microbiology
HERDC Category C1 - Journal Article (DEST)
Abstract Background. Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis.

Methods.
In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF], 263 µg per day administered intravenously) in ceftazidime-treated patients with severe sepsis caused by suspected melioidosis in Thailand.

Results. Over a 27-month period, 60 patients were enrolled to receive either G-CSF (30 patients, 18 of whom had culture-confirmed melioidosis) or placebo (30 patients, 23 of whom had culture-confirmed melioidosis). Mortality rates were similar in both groups (G-CSF group, 70%; placebo group, 87%; risk ratio, 0.81; 95% confidence interval, 0.61–1.06; P = .2), including among patients with confirmed melioidosis (83% vs. 96%; P = .3). The duration of survival was longer for patients who received G-CSF than for patients who received placebo (33 h vs. 18.6 h; hazard ratio, 0.56; 95% confidence interval, 0.31–1.00; P = .05).

Conclusions. Receipt of G-CSF is associated with a longer duration of survival but is not associated with a mortality benefit in patients with severe sepsis who are suspected of having melioidosis in Thailand. We hypothesize that G-CSF may “buy time” for severely septic patients, but survival is more likely to be improved by management of associated metabolic abnormalities and organ dysfunction associated with severe sepsis.
DOI http://dx.doi.org/10.1086/519261   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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