Trifilio Steven, Mehta Jayesh
Northwestern Memorial Hospital and Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Adv Pract Oncol. 2019 Sep-Oct;10(7):685-690. doi: 10.6004/jadpro.2019.10.7.4. Epub 2019 Sep 1.
Most patients who undergo hematopoietic stem cell transplantation develop neutropenic fever and are at high risk for developing potentially life-threatening infections. β-lactam antibiotics remain the cornerstone for initial empiric treatment of neutropenic fever. In cancer patients with allergy or intolerance to β-lactams, guidelines recommend using aztreonam with vancomycin (AV) for neutropenic fever treatment. To date, the efficacy of AV for the treatment of neutropenic fever during stem cell transplantation is unknown. A retrospective study was conducted to identify hematopoietic stem cell transplantation recipients who were initially treated with concomitant AV for neutropenic fever between 2007 and 2013. Febrile neutropenia was classified as neutropenia with unexplained fever, neutropenic fever with a local source of infection, or neutropenic fever with a microbiologically documented infection. Seventy-six patients were identified who received AV as initial treatment for neutropenic fever over the study period. Responses to AV for neutropenia with unexplained fever (n = 41), febrile neutropenia with local site of infection (n = 11 [pneumonia = 9, other = 2]), and neutropenic fever with microbiologically documented infection (n = 34) were 75%, 55% (45% pneumonia), and 46% respectively. Infection-related mortality was 5%. Aztreonam with vancomycin was effective in treating neutropenia with unexplained fever. For patients with neutropenic fever and local source or microbiologically documented infection, alternative antibiotic treatments should be considered.
大多数接受造血干细胞移植的患者会出现中性粒细胞减少性发热，并有发生潜在危及生命感染的高风险。β-内酰胺类抗生素仍然是中性粒细胞减少性发热初始经验性治疗的基石。对于对β-内酰胺类过敏或不耐受的癌症患者，指南推荐使用氨曲南联合万古霉素（AV）治疗中性粒细胞减少性发热。迄今为止，AV在干细胞移植期间治疗中性粒细胞减少性发热的疗效尚不清楚。进行了一项回顾性研究，以确定2007年至2013年间最初接受AV联合治疗中性粒细胞减少性发热的造血干细胞移植受者。发热性中性粒细胞减少症分为不明原因发热的中性粒细胞减少症、有局部感染源的中性粒细胞减少性发热或有微生物学记录感染的中性粒细胞减少性发热。在研究期间，确定了76例接受AV作为中性粒细胞减少性发热初始治疗的患者。AV对不明原因发热的中性粒细胞减少症（n = 41）、有局部感染部位的发热性中性粒细胞减少症（n = 11 [肺炎 = 9，其他 = 2]）和有微生物学记录感染的中性粒细胞减少性发热（n = 34）的反应分别为75%、55%（肺炎为45%）和46%。感染相关死亡率为5%。氨曲南联合万古霉素对治疗不明原因发热的中性粒细胞减少症有效。对于有局部感染源或有微生物学记录感染的中性粒细胞减少性发热患者，应考虑替代抗生素治疗。
