Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline
Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2012.45.8661
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发表时间：
2013-02-20
影响因子：
45.3
通讯作者：
Ramsey, Scott D.
中科院分区：
文献类型：
--
作者：
Flowers, Christopher R.;Seidenfeld, Jerome;Ramsey, Scott D.
目的为成人中性粒细胞减少性肿瘤患者的抗菌药物预防以及发热、中性粒细胞减少症患者的选择和治疗提供指导。主要结果包括：中性粒细胞减少性发热门诊患者出现发热和/或感染，中性粒细胞减少性发热门诊患者恢复正常，无并发症和总死亡率。次要结果包括：在非发热的中性粒细胞减少的门诊患者中，感染相关的死亡率；在发热和中性粒细胞减少的门诊患者中，不改变治疗方案的退热、退热时间、感染并发症和复发；以及在两组中，住院时间、持续时间和抗微生物药物的不良反应。一个专家小组根据提取的数据和非正式共识制定了指南。结果43项研究中的47篇文章符合选择标准。建议仅推荐中性粒细胞数为100个/亩的L治疗7天的患者使用抗菌和抗真菌预防措施，除非其他因素增加了类似水平的并发症或死亡的风险。住院治疗是管理中性粒细胞减少的发热发作的标准，尽管精心挑选的患者可能会在以有效的风险指数(例如，多国癌症支持护理协会[MASCC]评分或Talcott规则)开始进行系统评估后作为门诊患者进行管理。MASCC评分<21分或Talcott组4分且无其他危险因素的患者可以安全地作为门诊患者进行管理。中性粒细胞减少的发热患者应在分诊后一小时内接受初步剂量的经验性抗菌治疗，并应至少监测4小时以确定是否适合门诊治疗，或入院治疗。推荐口服氟喹诺酮加阿莫西林/克拉维酸(或如果青霉素过敏则加克林霉素)作为经验性治疗，除非在发烧之前使用氟喹诺酮预防。J Clin Oncol31：794-810。(C)美国临床肿瘤学会2013年
PurposeTo provide guidelines on antimicrobial prophylaxis for adult neutropenic oncology outpatients and on selection and treatment as outpatients of those with fever and neutropenia.MethodsA literature search identified relevant studies published in English. Primary outcomes included: development of fever and/or infections in afebrile neutropenic outpatients and recovery without complications and overall mortality in febrile neutropenic outpatients. Secondary outcomes included: in afebrile neutropenic outpatients, infection-related mortality; in outpatients with fever and neutropenia, defervescence without regimen change, time to defervescence, infectious complications, and recurrent fever; and in both groups, hospital admissions, duration, and adverse effects of antimicrobials. An Expert Panel developed guidelines based on extracted data and informal consensus.ResultsForty-seven articles from 43 studies met selection criteria.RecommendationsAntibacterial and antifungal prophylaxis are only recommended for patients expected to have < 100 neutrophils/mu L for > 7 days, unless other factors increase risks for complications or mortality to similar levels. Inpatient treatment is standard to manage febrile neutropenic episodes, although carefully selected patients may be managed as outpatients after systematic assessment beginning with a validated risk index (eg, Multinational Association for Supportive Care in Cancer [MASCC] score or Talcott's rules). Patients with MASCC scores >= 21 or in Talcott group 4, and without other risk factors, can be managed safely as outpatients. Febrile neutropenic patients should receive initial doses of empirical antibacterial therapy within an hour of triage and should either be monitored for at least 4 hours to determine suitability for outpatient management or be admitted to the hospital. An oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin if penicillin allergic) is recommended as empiric therapy, unless fluoroquinolone prophylaxis was used before fever developed. J Clin Oncol 31:794-810. (C) 2013 by American Society of Clinical Oncology