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Abstract. This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that. Risk of febrile neutropenia (FN) should be systematically assessed (in consultation with infectious disease specialists as needed), including. Febrile neutropenia (FN) is a serious complication of cancer chemotherapy that The Infectious Diseases Society of America (IDSA), National.

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In the absence of effector cells, primarily neutrophils, signs and symptoms of inflammation may be lacking and rapid progression of invasive bacterial infections may occur, so antibiotics are a life-saving measure in this situation.

The focus of this guideline is the initial risk period during neutropenia. If methicillin-resistant Staphylococcus aureus is suspected, the initial antibiotic regimen can be modified to include vancomycin, daptomycin, or linezolid.

CT may reveal abnormalities in either the lungs or the sinuses. For management of most patients, the Panel recommends involvement of febripe infectious diseases specialist knowledgeable about infections of the immunocompromised host.

IDSA GUIDELINES Bundle (free trial)

Another important unresolved question is use of the preemptive antifungal approach in patients who are already receiving anti-mold prophylaxis [ ]. The primary reason for the ferbile use of vancomycin has been the epidemiological link between its overuse and the development of drug resistance in Enterococcus species and Disa.

Consider early addition of vancomycin, linezolid, or daptomycin B-III. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. The appropriate duration of anti-mold prophylaxis in high-risk patients is uncertain.

An evidence-based evaluation of important aspects of empirical neutropemia therapy in febrile neutropenic patients. The primary aim of the practice guideline is to assist practitioners in making decisions about appropriate care for neutropenic patients who present with signs and symptoms of potentially serious infections [ 18 ]. An important exception, as noted above, is for low-risk outpatients who are being treated with empirical oral or IV therapy.


Skin care during neutropenia should also include daily inspection of skin sites likely to be portals of infection eg, the perineum and intravascular access sites. The specimen can be tested by PCR, direct antigen assay, or culture for respiratory viruses febrilw influenza, parainfluenza, adenovirus, RSV, and human metapneumovirus [ ].

IDSA GUIDELINES Bundle (free trial) – Fever and Neutropenia

Meropenem monotherapy versus combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients.

In evaluating the evidence regarding the management of patients with fever and neutropenia, the Panel used a systematic weighting of the level and grade of the evidence for making a recommendation Table 2 [ 19 ]. In low-risk patients without documented infection, continuing antibiotic therapy until resolution of both fever and neutropenia is the standard approach.

Risk assessment may determine the type of empirical antibiotic therapy oral vs intravenous [IV]venue of treatment inpatient vs outpatientand duration of antibiotic therapy A-II.

Risk assessment in cancer patients with fever and neutropenia: Detection of bacteremia in adults: Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm.

Once blood culture results and organism suscepibilities are available—usually within several days after blood samples are drawn—they may direct a more specific choice of antibiotics. Febrile neutropenia FN is a serious complication of neutropenoa chemotherapy that can lead to delays in treatment and necessary dose reductions of chemotherapy, which compromise treatment efficacy.

Risk factors include previous infection or colonization with the organism and treatment in a hospital with high rates of endemicity. Risk assessment and treatment of low-risk patients with febrile neutropenia.

Risk factors for recurrent fever after the discontinuation of empiric antibiotic therapy for fever and neutropenia in pediatric patients with a malignancy or hematologic condition. A switch from one empirical monotherapy to another or the addition of an aminoglycoside to the treatment regimen is also not generally useful, unless there is a need for an expanded spectrum of coverage as dictated by clinical or microbiologic neuropenia.

Guidelines in the Management of Febrile Neutropenia for Clinical Practice

The antibiotic spectrum can be appropriately narrowed to specifically treat the defined infection once fever has resolved. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens.


Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients. In addition, psychosocial and logistic considerations are outlined within the guideline.

Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer.

Fever and Neutropenia in Adults with Cancer

Primary prophylaxis—the use of CSFs for prevention in the first cycle of treatment for many solid tumors—does appear to reduce the incidence of fever and neutropenia and is likely to be most cost-effective.

If societal costs are considered, the economic impact of fever and neutropenia becomes more apparent, and there may be recognition of greater cost-saving benefits of CSFs [ ]. Patients who remain hemodynamically unstable after initial doses with standard agents for neutropenic fever should have their antimicrobial regimen broadened to include coverage for resistant gram-negative, gram-positive, and anaerobic bacteria and fungi A-III.

Furthermore, the selection of patients who may benefit the most from antimicrobial prophylaxis see Section VI is based upon these criteria for being at high risk, which are derived from clinical trials [ 20—41 ]. These include pre-engraftment allogeneic HSCT recipients receiving myeloablative conditioning regimens, some autologous HSCT recipients unsupported by hematopoietic growth factors, and patients undergoing intensive induction chemotherapy regimens for AML with severe oral and gastrointestinal mucositis [].

Outpatient therapy with oral ofloxacin for patients with low risk neutropenia and fever: Although overall rates of mortality were not different between patients randomized to preemptive versus empirical antifungal therapy, there were more episodes of invasive fungal infection and a trend toward more fungal-related deaths among those treated with preemptive therapy [ ].