Περίληψη:
Over the past several decades, there has been substantial progress in
the management of patients with febrile neutropenia. However, the
ever-changing patterns of infection, ecology, and antibiotic-resistance
trends do not allow the development of treatment guidelines that could
be applied universally. Hence, the institution’s predominant pathogens
and resistance patterns should guide the empirical choice of
antimicrobials. Prompt initiation of antimicrobial therapy remains the
gold standard. Monotherapy with the newer broad-spectrum antimicrobials
has tended to replace the classic combination therapy. Empirical
administration of glycopeptides, such as vancomycin, without
documentation of a gram-positive infection is not favored. The
development of risk-stratification models has allowed for identification
of low-risk patients with additional treatment options, such as early
discharge and exclusively outpatient treatment with oral antimicrobials.
The initiation of empirical antifungal therapy in persistently febrile
neutropenic patients has become common practice, especially recently,
since the introduction of new, effective, less toxic antifungal drugs.
It is hoped that the development of new nonculture-based diagnostic
methods will allow for the early detection of invasive fungal infections
and, thus, the replacement of empirical antifungal therapy with
pathogen-specific, preemptive therapy.
Συγγραφείς:
Sipsas, NV
Bodey, GP
Kontoyiannis, DP
