Donowitz G R, Maki D G, Crnich C J, Pappas P G, Rolston K V
University of Virginia Health System, Charlottesville 22908-1343, USA.
Hematology Am Soc Hematol Educ Program. 2001:113-39. doi: 10.1182/asheducation-2001.1.113.
Infection in the neutropenic patient has remained a major clinical challenge for over three decades. While diagnostic and therapeutic interventions have improved greatly during this period, increases in the number of patients with neutropenia, changes in the etiologic agents involved, and growing antibiotic resistance have continued to be problematic. The evolving etiology of infections in this patient population is reviewed by Dr. Donowitz. Presently accepted antibiotic regimens and practices are discussed, along with ongoing controversies. In Section II, Drs. Maki and Crnich discuss line-related infection, which is a major infectious source in the neutropenic. Defining true line-related bloodstream infection remains a challenge despite the fact that various methods to do so exist. Means of prevention of line related infection, diagnosis, and therapy are reviewed. Fungal infection continues to perplex the infectious disease clinician and hematologist/oncologist. Diagnosis is difficult, and many fungal infections will lead to increased mortality even with rapid diagnosis and therapy. In Section III, Dr. Pappas reviews the major fungal etiologies of infection in the neutropenic patient and the new anti-fungals that are available to treat them. Finally, Dr. Rolston reviews the possibility of outpatient management of neutropenic fever. Recognizing that neutropenics represent a heterogeneous group of patients, identification of who can be treated as an outpatient and with what antibiotics are discussed.
三十多年来，中性粒细胞减少患者的感染一直是一项重大临床挑战。在此期间，尽管诊断和治疗干预措施有了很大改进，但中性粒细胞减少患者数量的增加、所涉及病原体的变化以及抗生素耐药性的不断上升仍然是问题。多诺维茨博士回顾了该患者群体感染病因的演变。文中讨论了目前公认的抗生素治疗方案和做法，以及存在的争议。在第二部分，马基博士和克里尼奇博士讨论了与导管相关的感染，这是中性粒细胞减少患者的主要感染源。尽管存在多种定义真正与导管相关的血流感染的方法，但确定其仍然是一项挑战。文中回顾了预防与导管相关感染、诊断和治疗的方法。真菌感染仍然困扰着传染病临床医生和血液科/肿瘤科医生。诊断困难，即使快速诊断和治疗，许多真菌感染仍会导致死亡率上升。在第三部分，帕帕斯博士回顾了中性粒细胞减少患者感染的主要真菌病因以及可用于治疗这些病因的新型抗真菌药物。最后，罗尔斯顿博士回顾了中性粒细胞减少性发热门诊治疗的可能性。认识到中性粒细胞减少患者是一个异质性群体，文中讨论了确定哪些患者可以门诊治疗以及使用何种抗生素。
