Vossen Matthias Gerhard, Milacek Christopher, Thalhammer Florian
Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Wien, Austria.
ESMO Open. 2018 Jun 13;3(3):e000348. doi: 10.1136/esmoopen-2018-000348. eCollection 2018.
Neutropenic sepsis in haemato-/oncological patients is a medical emergency, as infections may show a fulminant clinical course. Early differentiation between sepsis and febrile neutropenic response often proves to be challenging. To assess the severity of the illness, different tools, which are discussed in this article, are available. Once the diagnosis has been established, the correct use of early empirical antibiotic and antifungal treatment is key in improving patient survival. Therefore, profound knowledge of local resistance patterns is mandatory and carefully designed antibiotic regimens have to be established in cooperation with local microbiologists or infectious diseases specialists. In the following, identification, therapy and management of high-risk, neutropenic patients will be reviewed based on experimental and clinical studies, guidelines and reviews.
血液/肿瘤患者的中性粒细胞减少性败血症是一种医疗急症,因为感染可能呈现暴发性临床病程。败血症与发热性中性粒细胞减少反应的早期鉴别往往具有挑战性。本文将讨论用于评估疾病严重程度的不同工具。一旦确诊,正确使用早期经验性抗生素和抗真菌治疗是提高患者生存率的关键。因此,必须深入了解当地的耐药模式,并与当地微生物学家或传染病专家合作制定精心设计的抗生素治疗方案。以下将根据实验和临床研究、指南及综述对高危中性粒细胞减少患者的识别、治疗和管理进行综述。