Division of Infectious Diseases, Vanderbilt University Medical Center, A2200 MCN, 1161 21st Avenue South, Nashville, TN 37232-2605, USA.
Infect Dis Clin North Am. 2019 Jun;33(2):381-397. doi: 10.1016/j.idc.2019.02.003.
Fever is a common complication in patients with underlying neutropenia and is associated with significant mortality in neutropenic patients with acute myelogenous leukemia or hematopoietic cell transplant. Fever may be the only sign of infection and requires further clinical assessment, including a history, a physical examination, and additional laboratory and radiographic testing. National and international guidelines recommend initiation of empiric antimicrobial therapy in patients with fever during neutropenia. Stepwise escalation of antibacterial therapy, followed by antifungal therapy for patients with persistent fever, generally is recommended. Consideration should also be given to de-escalation of antimicrobial therapy in the appropriate clinical settings.
发热是中性粒细胞减少症患者的常见并发症，与急性髓细胞性白血病或造血细胞移植的中性粒细胞减少症患者的显著死亡率相关。发热可能是感染的唯一迹象，需要进一步的临床评估，包括病史、体格检查以及其他实验室和影像学检查。国家和国际指南建议在中性粒细胞减少症患者发热时开始经验性抗菌治疗。一般建议对发热持续的患者逐步升级抗菌治疗，然后进行抗真菌治疗。在适当的临床情况下，也应考虑降低抗菌治疗的强度。
