de la Court J R, Bruns A H W, Roukens A H E, Baas I O, van Steeg K, Toren-Wielema M L, Tersmette M, Blijlevens N M A, Huis In 't Veld R A G, Wolfs T F W, Tissing W J E, Kyuchukova Y, Heijmans J
Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam, The Netherlands.
Infect Dis Ther. 2022 Dec;11(6):2063-2098. doi: 10.1007/s40121-022-00700-1. Epub 2022 Oct 14.
This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and pediatric patients.
The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010-2020) and, where necessary, supplemented by expert-based advice.
For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients.
This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin-tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended.
本指南由一个多学科委员会编写，其成员包括荷兰传染病学会、荷兰血液学学会、荷兰医学肿瘤学学会、荷兰医院药剂师协会、荷兰医学微生物学学会和荷兰儿科学会的指定成员。该指南适用于成人和儿童患者。
这些建议基于指南委员会提出的九个问题的答案。为了提供循证建议，我们将2010年以来发布的所有相关临床指南作为资料来源，并辅以对近期文献（2010 - 2020年）的系统检索和评估，必要时补充基于专家的建议。
对于成人，该指南根据中性粒细胞减少的预期持续时间（> 7天与≤ 7天）区分高危和标准风险中性粒细胞减少。尽可能对儿童和成人患者进行了区分。
本指南旨在协助荷兰化疗引起的发热性中性粒细胞减少患者的诊断和管理。该指南为儿童和成人提供了建议。成人患者根据中性粒细胞减少的估计持续时间分为标准风险或高危中性粒细胞减少发作。最重要的建议如下。在高危中性粒细胞减少的成人（中性粒细胞减少持续时间> 7天）和中性粒细胞减少的儿童中，头孢他啶、头孢吡肟和哌拉西林 - 他唑巴坦都是发热时经验性抗生素治疗的首选药物。在标准风险中性粒细胞减少的成人（中性粒细胞减少持续时间≤ 7天）中，MASCC评分可用于评估感染并发症的个体风险。对于感染并发症风险低（MASCC评分高）的患者，建议在门诊进行口服抗生素治疗。对于感染并发症风险高（MASCC评分低）的患者，建议按照不明原因脓毒症的方案进行抗生素治疗。
