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/cir073
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发表时间：
2011-02-01
影响因子：
11.8
通讯作者：
Wingard, John R.
中科院分区：
文献类型：
--
作者：
Freifeld, Alison G.;Bow, Eric J.;Wingard, John R.
本文件更新和扩展了最初的美国传染病学会（IDSA）发热和中性粒细胞增多症指南，该指南于1997年出版，并于2002年首次更新。本指南旨在指导化疗引起发热和中性粒细胞减少的癌症患者如何使用抗菌药物。抗菌药物开发和技术的最新进展、临床试验结果以及广泛的临床经验为本文的方法和建议提供了依据。由于该指南在2002年的上一次迭代，我们对哪些癌症患者人群可能从抗生素、抗真菌和抗病毒预防中获益最大有了更清晰的定义。此外，根据表现出的体征和症状、潜在癌症、治疗类型和医学合并症将贫血患者分类为感染的高风险或低风险已成为治疗算法的关键。风险分层是管理发热和中性粒细胞减少患者的推荐起点。此外，侵袭性真菌感染的早期检测导致了关于经验性或先发制人的抗真菌治疗的最佳使用的争论，尽管算法仍在发展，但没有改变的是立即经验性抗生素治疗的适应症。所有出现发热和中性粒细胞减少症的患者都应迅速和广泛地使用抗生素进行治疗，以治疗革兰氏阳性和革兰氏阴性病原体。最后，我们注意到专家组所有成员都来自美国或加拿大的机构;因此，这些指南是在北美实践的背景下制定的。一些建议可能不适用于北美以外的地区，这些地区存在可用抗生素、主要病原体和/或医疗保健相关经济条件的差异。无论在何处，临床警戒和立即治疗是管理发热和/或感染的贫血患者的通用关键。
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.