1
|
Alali M, Prather C, Danziger-Isakov LA, Kussin ML, Khalifeh M, Al Othman N, Bartlett AH. Absolute Monocyte Count as Early and Safe Marker for Antibiotic Cessation in Febrile Neutropenia Without Etiology in Pediatric Oncology Patients. J Pediatr Hematol Oncol 2023; 45:e702-e709. [PMID: 37494607 DOI: 10.1097/mph.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/23/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND There is no practice standard regarding antibiotic duration in children with cancer and unexplained febrile neutropenia (FN). We hypothesized that absolute monocyte count (AMC) and absolute phagocyte count (APC= ANC + AMC + bands) are more sensitive, earlier, and safe markers of antibiotic cessation compared with absolute neutrophil count (ANC). METHODS A retrospective review of FN episodes (FNEs) in pediatric oncology patients was conducted between 2009 and 2016. Included patients were afebrile for 24 hours and without an identified infectious source at antibiotic cessation. Primary endpoints, including recurrent fever, readmission, bloodstream infection, microbiologically documented infection, and adverse outcomes, were assessed 10 days after antibiotic cessation and compared among different bone marrow recovery parameters (ANC, AMC, APC). Secondary endpoints included length of FN stay, antibiotic-free days, and cost. RESULTS Three hundred ninety-one FNEs in 235 patients were included. Three groups were compared based on ANC (cells/μL) at the time of antibiotic cessation: < 200 in 102 (26%), 200 to 500 in 111 (28%), and >500 in 178 (46%). No statistically significant differences in primary endpoints were identified among the 3 ANC groups; however, a trend toward unfavorable outcomes in the ANC ≤200 cells/μL group compared with the ANC >200 cells/μL was observed. Primary endpoints based on AMC >100 cells/μL at the time of antibiotic cessation showed statistically significant favorable outcomes compared AMC ≤100 cells/μL (80%, 88%, 90%, 89%, and 93% risk reduction in recurrent fever, readmission, new bloodstream infection, new microbiologically documented infection, and adverse events, respectively). Similar favorable results were seen when APC >300 cells/μL was used as a threshold for antibiotic cessation. The median length of stay for FN if discharged when AMC >100 cells/μL was 3 days shorter and associated with fewer unfavorable outcomes, thus resulting in fewer hospital days, fewer antibiotic days, and decreased cost. CONCLUSION Our results suggest that AMC >100 cells/μL (regardless of ANC) or APC >300 cells/μL may be safe thresholds for empiric antibiotic cessation and result in reduced unfavorable clinical outcomes within 10 days postdischarge, reduced antibiotic days of therapy and reduced health care costs. Further prospective studies are needed to validate AMC as an accurate surrogate marker for antibiotic cessation in FNEs in children with cancer.
Collapse
Affiliation(s)
- Muayad Alali
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Indiana University Health and Ryan White Center for Pediatric Infectious Diseases & Global Health
| | - Cassandra Prather
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Lara A Danziger-Isakov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michelle L Kussin
- Department of Pharmacy Riley Hospital for Children at Indiana University Health and Ryan White Center for Pediatric Infectious Diseases & Global Health, Indiana University, Indianapolis, IN
| | - Malak Khalifeh
- Department of Biostatistics & Research, Stony Brook University, Stony Brook, NY
| | | | - Allison H Bartlett
- Division of Infectious Diseases, Department of Pediatrics, University of Chicago Medicine, Chicago, IL
| |
Collapse
|
2
|
Hu CC, Subramanian R, Grigg A. Evaluation of a safe neutrophil count for cessation of intravenous antibiotics and early hospital discharge in stable, afebrile patients recovering after acute myeloid leukemia therapy or an autograft. Leuk Lymphoma 2023; 64:1322-1329. [PMID: 37081819 DOI: 10.1080/10428194.2023.2203289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
Currently there are no guidelines on a safe neutrophil count(ANC) for intravenous antibiotic(IVAB) cessation and hospital discharge in patients recovering after febrile neutropenia(FN). We assessed the safety in selected patients after recent FN of prompt IVAB cessation and hospital discharge. Safety was defined as no fever recurrence after IVAB cessation and readmission in the 10-days post-discharge for infections.A retrospective, single center audit conducted on 92 adult hematology patients admitted with de novo acute myeloid leukemia (AML) for intensive chemotherapy or for an autograft. Most admissions (n = 128/141;91%) were complicated by FN. Half of FN episodes ceased IVAB promptly with a median(range) ANC of 0.6(0.1-4.9x109/L); none of these episodes had recurrent fever requiring IVAB resumption. Prompt discharge occurred in 45% overall. Subsequent unplanned readmission rates were low.In afebrile, stable AML and autograft patients without medico-social barriers to discharge, IVAB can be ceased and hospital discharges safely done ≤24h of ANC ≥ 0.2x109/L.
Collapse
Affiliation(s)
- Chih-Chiang Hu
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Rakhee Subramanian
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Patel VM, Chu B, Hamilton KW, Bellamy C, Harker C, Bryer JS, Shields B, Hirsh RL, Fadugba OO, Micheletti RG. Penicillin allergy evaluation in hospitalized patients with hematologic malignancy. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e92. [PMID: 37228506 PMCID: PMC10204135 DOI: 10.1017/ash.2023.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 05/27/2023]
Abstract
A penicillin allergy testing service (PATS) assessed penicillin allergy in patients with hematologic malignancies; 17 patients who met criteria had negative skin testing. Patients who underwent penicillin challenge passed and were delabeled. Of delabeled patients, 87% received and tolerated β-lactams during follow-up. Providers found the PATS valuable.
Collapse
Affiliation(s)
- Vima M. Patel
- Section of Allergy and Immunology, Division of Pulmonary Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Chu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith W. Hamilton
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cassandra Bellamy
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christina Harker
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua S. Bryer
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bridget Shields
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin
| | - Rebecca L. Hirsh
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Olajumoke O. Fadugba
- Section of Allergy and Immunology, Division of Pulmonary Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G. Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Carcò D, Markovic U, Castorina P, Iachelli V, Pace T, Guardo P, Amato G, Galbo F, Scirè P, Moschetti G. C-Reactive Protein Monitoring and Clinical Presentation of Fever as Predictive Factors of Prolonged Febrile Neutropenia and Blood Culture Positivity after Autologous Hematopoietic Stem Cell Transplantation-Single-Center Real-Life Experience. J Clin Med 2022; 11:jcm11020312. [PMID: 35054007 PMCID: PMC8780345 DOI: 10.3390/jcm11020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Febrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient’s outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT). Methods: In this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantations. Results: Febrile neutropenia occurred a median of 7 days from ASCT. Median duration of FN was 2 days, with 25% of population that had fever for at least four days. Ten patients had at least one fever spike superior to 39 °C, while the median number of daily fever spikes was two. Twenty patients had positive blood cultures with XDR germs, namely Pseudomonas aeruginosa and Klebsiella pneumoniae, present in seven cases. ROC analysis of peak C-reactive protein (CRP) values was conducted based on blood culture positivity and a value of 12 mg/dL resulted significant. Onset of prolonged fever with a duration greater than 3 days was associated with the presence of both a peak number of three or more daily fever spikes (p = 0.02) and a body temperature greater than 39 °C (p = 0.04) based on odds ratio (OR). Blood culture positivity and peak CRP values greater than 12 mg/dL were also associated with prolonged fever duration, p = 0.04, and p = 0.03, respectively. The probability of blood culture positivity was also greater in association with fever greater than 39 °C (p = 0.04). Furthermore, peak CRP values below the cut-off showed less probability of positive blood culture (p = 0.02). Conclusions: In our study, clinical characteristics of fever along with peak CRP levels were associated with a higher probability of both prolonged fever duration and positive blood culture, needing extended antibiotic therapy.
Collapse
Affiliation(s)
- Daniela Carcò
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Uros Markovic
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
- Correspondence:
| | - Paolo Castorina
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
- Dipartimento di Fisica, Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
- Faculty of Mathematics and Physics, Charles University, V Holešovičkach 2, 18000 Prague, Czech Republic
- Dipartimento di Fisica e Astronomia, Università di Catania, 95123 Catania, Italy
| | - Valeria Iachelli
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Tecla Pace
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Paola Guardo
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Gabriella Amato
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Federica Galbo
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Paola Scirè
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Gaetano Moschetti
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| |
Collapse
|
5
|
Alali M, David MZ, Ham SA, Danziger-Isakov L, Pisano J. Febrile Neutropenia Syndromes in Children: Risk Factors and Outcomes of Primary, Prolonged, and Recurrent Fever. J Pediatr Hematol Oncol 2021; 43:e962-e971. [PMID: 34133386 DOI: 10.1097/mph.0000000000002221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The approach to recurrent febrile neutropenia (FN) in children with cancer has not been sufficiently addressed and was cited as a research gap in the International Pediatric Fever and Neutropenia (IPFNP) Guideline 2017. METHODS Retrospective medical record review for all pediatric cancer patients with a diagnosis of FN was performed. Variables were collected at 2 different time sets (at day 1 and day 4 of presentation). Three FN syndromes have been defined based on the duration and time course of the fever: (1) primary: fever resolved before 96 hours and did not follow with recurrent fever; (2) prolonged fever: episodes failing to defervesce after at least 96 hours of antibacterial therapy; (3) recurrent fever: a new episode of fever >72 hours after resolution of the initial fever when a patient remained neutropenic and on antibiotics or if a fever developed within 1 week after antibiotic discontinuation. These entities were compared with define risk factors and adverse outcomes associated with recurrent fever. RESULTS A total of 633 FN episodes (FNEs) were identified in 268 patients. Each FNE was classified as primary (n=453, 71.5%), prolonged (n=119, 18.7%), or recurrent (n=61, 9.7%). In multivariable analysis, acute myelogenous leukemia (odds ratio [OR]=4.6, 95% confidence interval [CI]: 2.95-7.24), allogeneic stem cell transplant (SCT) (OR=4.9, 95% CI: 2.61-7.35), absolute lymphocyte count <300/mm3 (OR=3.8, 95% CI: 1.30-5.02), prior neutropenia of ≥10 days, (OR=3.95, 95% CI: 1.70-5.93) and hypotension (OR=3.65, 95% CI: 1.30-5.86) on day 1 of presentation were all associated with an increased risk of recurrent fever when compared with primary fever. In subset analysis for only the high-risk FN group, hypotension (OR=3.2, 95% CI: 1.80-4.96), prior neutropenia ≥10 days (OR=2.55, 95% CI: 1.40-6.22), and absolute lymphocyte count <300/mm3 at presentation (OR=2.6, P=0.03, 95% CI: 2.65-7.12) were associated with an increased risk of recurrent fever when compared with high-risk FN not developing recurrent fever. Allogeneic SCT (OR=5.9, 95% CI: 2.65-7.12) and prior neutropenia ≥10 days (OR=2.11, 95% CI: 1.25-9.32) were significantly associated with recurrent fever when compared with prolonged fever. Invasive fungal disease was a more common etiology with recurrent fever compared with primary and prolonged fever (P=0.001 and 0.01, respectively). Recurrent fever episodes were more likely to be admitted to the pediatric intensive care unit (OR=3, 95% CI: 1.27-6.23) and had a higher 30-day mortality (OR=8, 95% CI: 1.87-71.85) when compared with primary fever. CONCLUSIONS Knowledge of risk factors for recurrent fever may enable the early detection infection-related complications of this high-risk group, and possible improved approaches to treatment resulting in decreased morbidity and mortality.
Collapse
Affiliation(s)
| | - Michael Z David
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA
| | - Sandra A Ham
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - Lara Danziger-Isakov
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Immunocompromised Host Infectious Disease Cincinnati, OH
| | - Jennifer Pisano
- Medicine, Division of Infectious Diseases, University of Chicago Medicine
| |
Collapse
|
6
|
Choi WK, D'Sa A, Holman JN, Javed S, Thompson S, Nadgir RN. Chest CT Has Higher Yield for Infection than CT Sinus in Febrile Neutropenic Patients. Curr Probl Diagn Radiol 2021; 51:340-343. [PMID: 34334225 DOI: 10.1067/j.cpradiol.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/29/2021] [Accepted: 06/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Chest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting. METHODS Reports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed. Infection as reported was characterized as acute or worsening, improving, stable, indeterminate or negative. Results were tabulated and Pearson's chi-square test was used for comparison analysis. RESULTS Absence of infection on CT sinus was significantly higher than CT chest (86.1% vs. 58.5%; P<0.001). Conversely, CT chest had significantly higher incidence of acute or worsening infection than CT sinus (28.7% vs. 11.6%; P<0.001). CT chest also showed significantly higher incidence of improving infection compared to CT sinus (6.2% vs. 1.1%; P<0.001). There was no significant difference between incidence of stable infection on CT chest and CT sinus (1.1% vs. 0.2%; P=0.059). Infection was indeterminate in 5.5% of CT chest vs. 1% on CT sinus (P<0.001). CONCLUSIONS CT chest showed significantly higher diagnostic yield for acute infection than CT sinus, suggesting that sinusitis is less likely to be the source of fever than chest infections in febrile neutropenic patients. The majority of CT studies showed absence of infection, raising the question of the overall utility of routine surveillance CT imaging among this subset of patients.
Collapse
Affiliation(s)
- Won Kyu Choi
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Adam D'Sa
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Joseph N Holman
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Samrah Javed
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Sarah Thompson
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Rohini N Nadgir
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD..
| |
Collapse
|
7
|
Lalaoui R, Javelle E, Bakour S, Ubeda C, Rolain JM. Infections Due to Carbapenem-Resistant Bacteria in Patients With Hematologic Malignancies. Front Microbiol 2020; 11:1422. [PMID: 32765433 PMCID: PMC7379235 DOI: 10.3389/fmicb.2020.01422] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022] Open
Abstract
In developed countries, hematological malignancies (HM) account for 8 to 10% of cancers diagnosed annually and one-third of patients with HM (HMP) are expected to die from their disease. The former wide spectrum “magic bullet,” imipenem, has been ousted by the emergence of carbapenem resistant (CR) pathogens. In endemic areas, infections with CR-bacteria occur in vulnerable patients, notably in HMP, who suffer from high mortality related to infectious complications. In this work, we reviewed epidemiologic and clinical factors associated with CR-infections in adult HMP and data on CR-related mortality and antibiotic treatments in this population. We found that resistance profile of strains involved in HMP infections, mainly bacteremia, reflect local epidemiology. Significant risk factors for infections with CR-bacteria include sex male, age around 50 years old, acute leukemia, selvage chemotherapy, neutropenia, and digestive colonization by CR-bacteria. Mortality rate is high in HMP infected with CR-Enterobacteriaceae, more particularly in case of acute myeloid leukemia and unresolved neutropenia, due to inappropriate empiric management and delayed administration of targeted antibiotics, such as tigecycline, colistin, or new associations of active drugs. Thus, we developed an algorithm for clinicians, assessing the incremental risk for CR-bacterial infection occurrence and mortality in febrile HMP, to guide decisions related to empirical therapeutic strategies.
Collapse
Affiliation(s)
- Rym Lalaoui
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Emilie Javelle
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Laveran Military Teaching Hospital, Marseille, France
| | - Sofiane Bakour
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Carles Ubeda
- Centro Superior de Investigación en Salud Pública, FISABIO, Valencia, Spain.,Centers of Biomedical Research Network (CIBER), Epidemiology and Public Health, Madrid, Spain
| | - Jean-Marc Rolain
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
8
|
Corrigendum to "Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update". Adv Hematol 2019; 2019:4120631. [PMID: 31379947 PMCID: PMC6662276 DOI: 10.1155/2019/4120631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
|
9
|
Cho SY, Lee HJ, Lee DG. Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea. Korean J Intern Med 2018; 33:256-276. [PMID: 29506345 PMCID: PMC5840605 DOI: 10.3904/kjim.2018.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/28/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a treatment for hematologic malignancies, immune deficiencies, or genetic diseases, ect. Recently, the number of HSCTs performed in Korea has increased and the outcomes have improved. However, infectious complications account for most of the morbidity and mortality after HSCT. Post-HSCT infectious complications are usually classified according to the time after HSCT: pre-engraftment, immediate post-engraftment, and late post-engraftment period. In addition, the types and risk factors of infectious complications differ according to the stem cell source, donor type, conditioning intensity, region, prophylaxis strategy, and comorbidities, such as graft-versushost disease and invasive fungal infection. In this review, we summarize infectious complications after HSCT, focusing on the Korean perspectives.
Collapse
Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Jeong Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Dong-Gun Lee, M.D. Division of Infectious Diseases, Department of Internal Medicine, The Catholic Blood and Marrow Transplantation Centre, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6003 Fax: +82-2-535-2494 E-mail:
| |
Collapse
|
10
|
Le Clech L, Talarmin JP, Couturier MA, Ianotto JC, Nicol C, Le Calloch R, Dos Santos S, Hutin P, Tandé D, Cogulet V, Berthou C, Guillerm G. Early discontinuation of empirical antibacterial therapy in febrile neutropenia: the ANTIBIOSTOP study. Infect Dis (Lond) 2018; 50:539-549. [PMID: 29451055 DOI: 10.1080/23744235.2018.1438649] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Immediate empirical antibiotic therapy is mandatory in febrile chemotherapy-induced neutropenia, but its optimal duration is unclear, especially in patients with fever of unknown origin (FUO). OBJECTIVES The primary objective of this 20-month prospective observational study was to evaluate the feasibility and safety of short-term antibiotic treatment in afebrile or febrile patients exhibiting FUO, irrespective of their neutrophil count. The secondary objective was to describe the epidemiology of all episodes of febrile neutropenia. METHODS In the first phase of the study, empirical antibiotic therapy in FUO patients was stopped after 48 h of apyrexia, in accordance with European Conference on Infections in Leukaemia guidelines (n = 45). In the second phase of the study, antibiotics were stopped no later than day 5 for all FUO patients, regardless of body temperature or leukocyte count (n = 37). RESULTS Two hundred and thirty-eight cases of febrile neutropenia in 123 patients were included. Neither the composite endpoint (p = .11), nor each component (in-hospital mortality (p = .80), intensive care unit admission (p = 0.48), relapse of infection ≤48 h after discontinuation of antibiotics (p = .82)) differed between the two FUO groups. Violation of protocol occurred in 17/82 episodes of FUO without any major impact on statistical results. Twenty-six (57.3%) and 22 (59.5%) FUO episodes did not relapse during hospital-stay (p = 1), and nine (20%) and five (13.5%) presented another FUO, respectively. One hundred and fifty-six episodes of febrile neutropenia (65.5%) were clinically or microbiologically documented, including 85 bacteremia. CONCLUSIONS These results suggest that early discontinuation of empirical antibiotics in FUO is safe for afebrile neutropenic patients.
Collapse
Affiliation(s)
- Lenaïg Le Clech
- a Department of Haematology , Brest Teaching Hospital , Brest , France.,b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France
| | - Jean-Philippe Talarmin
- b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France
| | | | | | - Christophe Nicol
- a Department of Haematology , Brest Teaching Hospital , Brest , France
| | - Ronan Le Calloch
- a Department of Haematology , Brest Teaching Hospital , Brest , France
| | | | - Pascal Hutin
- b Department of Internal Medicine, Infectious Diseases and Haematology , Cornouaille Hospital Quimper , Quimper , France
| | - Didier Tandé
- c Laboratory of Bacteriology , Brest Teaching Hospital , Brest , France
| | - Virginie Cogulet
- d Department of Pharmacy , Brest Teaching Hospital , Brest , France
| | - Christian Berthou
- a Department of Haematology , Brest Teaching Hospital , Brest , France
| | - Gaëlle Guillerm
- a Department of Haematology , Brest Teaching Hospital , Brest , France
| |
Collapse
|
11
|
Affiliation(s)
- Michael Paddock
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN; Department of Emergency Medicine, University of Minnesota, St. Paul, MN.
| | - Andrew Grock
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Thomas DeLoughery
- Division of Hematology & Medical Oncology, Oregon Health & Sciences University, Portland, OR
| | - Jessica Mason
- University of California, San Francisco- Fresno, Fresno, CA
| |
Collapse
|
12
|
Conn JR, Catchpoole EM, Runnegar N, Mapp SJ, Markey KA. Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection. PLoS One 2017; 12:e0178059. [PMID: 28542412 PMCID: PMC5438184 DOI: 10.1371/journal.pone.0178059] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/08/2017] [Indexed: 02/03/2023] Open
Abstract
Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a “real world” cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period. In this cohort, the 30-day mortality following confirmed blood stream infection (BSI) was 5.9%, which is lower than most reports in the recent literature. We compared the blood culture results of inpatients undergoing induction chemotherapy and outpatients presenting with fevers and found a significantly higher rate of proven BSI in the outpatient group. In all settings, gram-negative organisms were most common. The rate of resistance to first-line empiric antibiotics among pathogenic isolates was 11.6% in the whole cohort, independent of blood culture circumstances. There was a trend to higher resistance rates among inpatients undergoing induction chemotherapy compared to patients presenting to the emergency department (17.4% vs 7.5%) but this did not reach statistical significance. We also report low rates of ciprofloxacin resistance (5% of isolates), in a center where universal fluoroquinolone prophylaxis is not employed. Our low resistance and mortality rates support our current therapeutic strategies, however presence of resistant organisms across the spectrum of indications for BC collection highlights the importance of surveilling local patterns, escalating antimicrobial therapy in the deteriorating patient, and considering advanced techniques for the rapid identification of resistance in this patient population.
Collapse
Affiliation(s)
- Jason R. Conn
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Naomi Runnegar
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sally J. Mapp
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Kate A. Markey
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
- Haematology and Bone Marrow Transplantation Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
| |
Collapse
|
13
|
Rachow T, Schlüter V, Bremer-Streck S, Lindig U, Scholl S, Schlattmann P, Kiehntopf M, Hochhaus A, von Lilienfeld-Toal M. Measurement of piperacillin plasma concentrations in cancer patients with suspected infection. Infection 2017; 45:629-636. [DOI: 10.1007/s15010-017-1026-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/11/2017] [Indexed: 12/21/2022]
|
14
|
Clinical and microbiological characteristics of bloodstream infections among patients with haematological malignancies with and without neutropenia at a medical centre in northern Taiwan, 2008–2013. Int J Antimicrob Agents 2017; 49:272-281. [DOI: 10.1016/j.ijantimicag.2016.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022]
|
15
|
Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med 2016; 69:755-764. [PMID: 28041827 DOI: 10.1016/j.annemergmed.2016.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/21/2016] [Accepted: 11/04/2016] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE Although validated risk-stratification tools have been used to send low-risk febrile neutropenic patients home from clinic and inpatient settings, there is a dearth of research evaluating these scores in the emergency department (ED). We compare the predictive accuracy of the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for patients with chemotherapy-induced febrile neutropenia and presenting to the ED. METHODS We conducted a retrospective cohort study to evaluate all patients with febrile neutropenia (temperature ≥38°C [100.4°F], absolute neutrophil count <1,000 cells/μL) who presented to 2 academic EDs from June 2012 through January 2015. MASCC and CISNE scores were calculated for all subjects, and each visit was evaluated for several outcome variables, including inpatient length of stay, upgrade in level of care, clinical deterioration, positive blood culture results, and death. Descriptive statistics are reported and continuous variables were analyzed with Wilcoxon rank sum. RESULTS During our study period, 230 patients presented with chemotherapy-induced febrile neutropenia. The CISNE score identified 53 (23%) of these patients as low risk and was highly specific in the identification of a low-risk cohort for all outcome variables (98.3% specific, 95% confidence interval [CI] 89.7% to 99.9%; positive predictive value 98.1%, 95% CI 88.6% to 99.9%). Median length of stay was shorter for low-risk versus high-risk CISNE patients (3-day difference; P<.001). The MASCC score was much less specific (54.2%; 95% CI 40.8% to 67.1%) in the identification of a low-risk cohort. CONCLUSION Our results suggest that the CISNE score may be the most appropriate febrile neutropenia risk-stratification tool for use in the ED.
Collapse
|
16
|
Radial Ultrasound-Assisted Transbronchial Biopsy: A New Diagnostic Approach for Non-Resolving Pulmonary Infiltrates in Neutropenic Hemato-Oncological Patients. Lung 2016; 194:917-921. [PMID: 27704258 DOI: 10.1007/s00408-016-9947-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/26/2016] [Indexed: 12/19/2022]
Abstract
The role of radial-endobronchial ultrasound (R-EBUS) assisted transbronchial biopsy (TBB) for the diagnosis of peripheral pulmonary lesions is well established. However, no study has addressed its safety and value in hemato-oncological patients presenting with non-resolving infiltrates during persistent febrile neutropenia. To assess safety and feasibility of R-EBUS assisted TBB in severe thrombocytopenic and neutropenic patients. Over a period of 18 months, eight patients were assessed with R-EBUS assisted TBB after adequate platelet transfusion. This technique allowed precise localisation and sampling of the pulmonary lesions in seven of eight patients. In the seven patients, R-EBUS assisted TBB enabled treatment optimization. Invasive fungal infection was diagnosed in four patients, idiopathic acute fibrinous and organising pneumonia in three patients, and a granulomatous inflammation of undetermined origin in one patient. Importantly, no complications, such as bleeding, were observed. R-EBUS assisted TBB is a promising and safe procedure for the evaluation of nonresolving pulmonary infiltrates in febrile neutropenic hemato-oncological patients.
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Neutropenic fever is the most common infective complication in patients receiving cytotoxic chemotherapy, and may result in severe sepsis, septic shock and mortality. Advancements in approaches to empiric antimicrobial therapy and prophylaxis have resulted in improved outcomes. Mortality may, however, still be as high as 50% in high-risk cancer populations. The objective of this review is to summarize factors associated with reduced mortality in patients with neutropenic fever, highlighting components of clinical care with potential for inclusion in quality improvement programs. RECENT FINDINGS Risks for mortality are multifactorial, and include patient, disease and treatment-related factors. Historically, guidelines for management of neutropenic fever have focused upon antimicrobial therapy. There is, however, a recognized need for early identification of sepsis to enable timely administration of antibiotic therapy and for this to be integrated with a whole of systems approach within healthcare facilities. Use of Systemic Inflammatory Response Syndrome criteria is beneficial, but validation is required in neutropenic fever populations. SUMMARY In the context of emerging and increasing infections because of antimicrobial-resistant bacteria in patients with neutropenic fever, quality improvement initiatives to reduce mortality must encompass antimicrobial stewardship, early detection of sepsis, and use of valid tools for clinical assessment. C-reactive protein and procalcitonin hold potential for inclusion into clinical pathways for management of neutropenic fever.
Collapse
|
18
|
Teofili L, Valentini CG, Di Blasi R, Orlando N, Fianchi L, Zini G, Sica S, De Stefano V, Pagano L. Dose-Dependent Effect of Granulocyte Transfusions in Hematological Patients with Febrile Neutropenia. PLoS One 2016; 11:e0159569. [PMID: 27487075 PMCID: PMC4972400 DOI: 10.1371/journal.pone.0159569] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/04/2016] [Indexed: 01/17/2023] Open
Abstract
It is still under debate whether granulocyte transfusions (GTs) substantially increase survival in patients with febrile neutropenia. We retrospectively examined data relative to 96 patients with hematological malignancies receiving 491 GTs during 114 infectious episodes (IE). Patients were grouped according to the median doses of granulocytes transfused during the infectious episode (low-dose group: <1.5-x108 cells/Kg; standard-dose group: 1.5–3.0x108 cells/Kg and high-dose group: >3.0x108 cells/Kg). The impact of clinical, microbiological and GT-related variables on the infection-related mortality (IRM) was investigated. The IRM was not influenced by the number of GTs or by the total amount of granulocytes received, whereas a dose-related effect of the median dose received for IE was detected at univariate analysis (IRM of 18.4% in the standard-dose group, 44.4% in the low-dose group and 48.4% in the high-dose group, p = 0.040) and confirmed at multivariate analysis (OR 3.7, IC 95% 1.5–8.9; 0.004 for patients not receiving standard doses of GTs). Moreover, patients receiving GTs at doses lower or greater than standard had increased risk for subsequent ICU admission and reduced overall survival. The dose-related effect of GTs was confirmed in bacterial but not in fungal infections. Preliminary findings obtained from a subgroup of patients candidate to GTs revealed that levels of inflammatory response mediators increase in a dose-related manner after GTs, providing a possible explanation for the detrimental effect exerted by high-dose transfusions. GTs can constitute a valuable tool to improve the outcome of infections in neutropenic patients, provided that adequate recipient-tailored doses are supplied. Further investigations of the immunomodulatory effects of GTs are recommended.
Collapse
Affiliation(s)
- Luciana Teofili
- Institute of Hematology, Catholic University, Rome, Italy
- * E-mail:
| | | | | | | | - Luana Fianchi
- Institute of Hematology, Catholic University, Rome, Italy
| | - Gina Zini
- Institute of Hematology, Catholic University, Rome, Italy
| | - Simona Sica
- Institute of Hematology, Catholic University, Rome, Italy
| | | | - Livio Pagano
- Institute of Hematology, Catholic University, Rome, Italy
| |
Collapse
|
19
|
Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: Interpreting lung findings in chest computed tomography. RADIOLOGIA 2015. [PMCID: PMC7153726 DOI: 10.1016/j.rxeng.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients.
Collapse
|
20
|
Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: interpreting lung findings in chest computed tomography. RADIOLOGIA 2015; 57:455-70. [PMID: 26315258 PMCID: PMC7127573 DOI: 10.1016/j.rx.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/26/2015] [Accepted: 07/04/2015] [Indexed: 12/21/2022]
Abstract
La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.
Collapse
Affiliation(s)
- P Calvillo Batllés
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España.
| | - J Carreres Polo
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - J Sanz Caballer
- Servicio de Hematología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - M Salavert Lletí
- Unidad de Enfermedades Infecciosas, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - L Compte Torrero
- Servicio de Neumología, Hospital Politècnic i Universitari La Fe, Valencia, España
| |
Collapse
|
21
|
A Prospective Observational Study of Antibiotic Therapy in Febrile Neutropenia Patients with Hematological Malignances from Multiple centers in Northeast China. Int J Infect Dis 2015; 37:97-103. [DOI: 10.1016/j.ijid.2015.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 11/19/2022] Open
|
22
|
Nouér SA, Nucci M, Anaissie E. Tackling antibiotic resistance in febrile neutropenia: current challenges with and recommendations for managing infections with resistant Gram-negative organisms. Expert Rev Hematol 2015; 8:647-58. [DOI: 10.1586/17474086.2015.1060576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol 2014; 2014:986938. [PMID: 25525436 PMCID: PMC4265549 DOI: 10.1155/2014/986938] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/18/2014] [Accepted: 11/03/2014] [Indexed: 01/27/2023] Open
Abstract
Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.
Collapse
|