Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Clin Infect Dis. 2011 Feb 15;52(4):e56-93. doi: 10.1093/cid/cir073.
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.
本文件更新并扩展了最初的美国传染病学会（IDSA）发热和中性粒细胞减少症指南，该指南于 1997 年首次发表，并于 2002 年首次更新。它旨在作为指导癌症患者使用抗菌药物治疗化疗引起的发热和中性粒细胞减少症的指南。抗菌药物研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指南中的方法和建议提供了信息。自 2002 年上次更新该指南以来，我们已经明确了哪些癌症患者群体最有可能从抗生素、抗真菌和抗病毒预防中获益。此外，根据现有症状和体征、基础癌症、治疗类型和合并症，将中性粒细胞减少症患者归类为感染高风险或低风险对于治疗算法至关重要。风险分层是管理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性或预防性抗真菌治疗最佳使用的争论，尽管算法仍在不断发展。没有改变的是立即进行经验性抗生素治疗的指征。所有出现发热和中性粒细胞减少症的患者都应迅速广泛地使用抗生素治疗革兰阳性和革兰阴性病原体，这仍然是正确的。最后，我们注意到所有小组成员均来自美国或加拿大的机构；因此，这些指南是在北美的实践背景下制定的。一些建议可能在北美以外的地区并不适用，因为那里的抗生素可及性、主要病原体和/或与医疗保健相关的经济条件存在差异。无论在何处，临床警惕性和立即治疗是管理发热和/或感染的中性粒细胞减少症患者的普遍关键。
