Klastersky J
Infection. 1983;11 Suppl 2:S97-101. doi: 10.1007/BF01645297.
The recovery of an adequate granulocyte count after chemotherapy is the most important prognostic factor in neutropenic patients. In granulocytopenic patients, the risk of infection is very high and its course usually severe. Empiric antibiotic treatment must be started as soon as fever rises and blood cultures have been taken. The combination of an anti-pseudomonas penicillin with an aminoglycoside is presently the standard empiric therapy for febrile granulocytopenic patients. If the clinical response is inadequate, antimicrobial therapy should be adjusted to a bactericidal activity of greater than 1:16 in the serum. If antibiotic therapy fails, a fungal infection should be considered and amphotericin B added empirically. Patients must be closely supervised for superinfections. Therapeutic transfusions of granulocytes have proven useful in severe granulocytopenia and when antibiotic therapy has failed.
化疗后粒细胞计数恢复正常是中性粒细胞减少患者最重要的预后因素。在粒细胞减少的患者中，感染风险非常高，且病程通常较为严重。一旦发热并采集血培养样本后，必须立即开始经验性抗生素治疗。目前，抗假单胞菌青霉素与氨基糖苷类药物联合使用是发热性粒细胞减少患者的标准经验性治疗方法。如果临床反应不佳，抗菌治疗应调整为血清杀菌活性大于1:16。如果抗生素治疗失败，应考虑真菌感染并经验性添加两性霉素B。必须密切监测患者是否发生二重感染。已证明治疗性粒细胞输注在严重粒细胞减少以及抗生素治疗失败时有用。
