Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.
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DOI：
10.1093/cid/ciq147
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发表时间：
2011-01-01
影响因子：
11.8
通讯作者：
Wingard, J. R.
中科院分区：
文献类型：
--
作者：
Freifeld, A. G.;Bow, E. J.;Wingard, J. R.
本文件更新和扩展了美国传染病学会(IDSA)最初的发烧和中性粒细胞减少指南，该指南于1997年发布，并于2002年首次更新。它的目的是作为使用抗菌剂治疗癌症患者的指南，这些患者经历了化疗引起的发热和中性粒细胞减少症。抗菌药物开发和技术的最新进展、临床试验结果和丰富的临床经验为本文提出的方法和建议提供了依据。由于2002年该指南的上一次迭代，我们已经制定了一个更明确的定义，即哪些癌症患者群体可以从抗生素、抗真菌和抗病毒预防中受益最大。此外，根据出现的体征和症状、潜在的癌症、治疗类型和医学合并症将中性粒细胞减少的患者归类为感染的高风险或低风险已成为治疗算法的关键。风险分层是治疗发热和中性粒细胞减少症患者的推荐起点。此外，侵袭性真菌感染的早期检测导致了关于经验或先发制人抗真菌治疗的最佳使用的辩论，尽管算法仍在发展中。没有改变的是立即进行经验性抗生素治疗的适应症。所有出现发烧和中性粒细胞减少的患者都应该迅速和广泛地使用抗生素治疗，以治疗革兰氏阳性和革兰氏阴性病原体。最后，我们注意到，小组所有成员都来自美国或加拿大的机构；因此，这些准则是在北美做法的背景下制定的。有些建议可能不适用于北美以外的地区，在可用抗生素、主要病原体和/或与卫生保健相关的经济条件存在差异的地区。无论地点如何，临床警觉和立即治疗是管理有发烧和/或感染的中性粒细胞减少症患者的通用关键。本文更新和扩展了1997年发布并于2002年首次更新的最初的美国传染病学会(IDSA)发烧和中性粒细胞减少症指南。它的目的是作为使用抗菌剂治疗癌症患者的指南，这些患者经历了化疗引起的发热和中性粒细胞减少症。抗菌药物开发和技术的最新进展、临床试验结果和丰富的临床经验为本文提出的方法和建议提供了依据。由于2002年该指南的上一次迭代，我们已经制定了一个更明确的定义，即哪些癌症患者群体可以从抗生素、抗真菌和抗病毒预防中受益最大。此外，根据出现的体征和症状、潜在的癌症、治疗类型和医学合并症将中性粒细胞减少的患者归类为感染的高风险或低风险已成为治疗算法的关键。风险分层是治疗发热和中性粒细胞减少症患者的推荐起点。此外，侵袭性真菌感染的早期检测导致了关于经验或先发制人抗真菌治疗的最佳使用的辩论，尽管算法仍在发展中。没有改变的是立即进行经验性抗生素治疗的适应症。所有出现发烧和中性粒细胞减少的患者都应该迅速和广泛地使用抗生素治疗，以治疗革兰氏阳性和革兰氏阴性病原体。最后，我们注意到，小组所有成员都来自美国或加拿大的机构；因此，这些准则是在北美做法的背景下制定的。有些建议可能不适用于北美以外的地区，在可用抗生素、主要病原体和/或与卫生保健相关的经济条件存在差异的地区。无论地点如何，临床警觉和立即治疗是处理有发烧和/或感染的中性粒细胞减少患者的通用关键。
This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. 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. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. 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. What has not changed is the indication for immediate empirical antibiotic therapy. 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. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. 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. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. 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. What has not changed is the indication for immediate empirical antibiotic therapy. 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. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.