Bajko G, Kubiak A, Hansz J
Klinika Hematologii A.M. w Poznaniu.
Acta Haematol Pol. 1995;26(1):15-26.
Infection is the most frequent cause of death in patients with severe neutropenia. Fever and other signs of infection with neutrophil count below 0.5 G/L require an early and rapid treatment--the empiric antibiotic therapy. This treatment comprises various combinations of bactericidal broad-spectrum antibiotics such as ureidopenicillins, cephalosporins, quinolones and aminoglycosides. If defervescence is not attained within 3 days, modification of the treatment scheme should be done. The addition of vancomycin or teicoplanin, antibiotics active against Gram + cocci, and changing of the beta-lactams should be considered. In the case of persistent microbiologically not recognized infection after 7 days of therapy, empiric antimycotic treatment with amphotericin B is indicated. Duration of the empiric antibiotic therapy is dependent on the granulocyte recovery and the resolution of infection.
感染是严重中性粒细胞减少症患者最常见的死亡原因。对于发热及中性粒细胞计数低于0.5×10⁹/L的其他感染迹象，需要尽早且迅速地进行治疗——经验性抗生素治疗。这种治疗包括多种杀菌性广谱抗生素的联合使用，如脲基青霉素、头孢菌素、喹诺酮类和氨基糖苷类。如果3天内未退热，则应调整治疗方案。应考虑加用对革兰氏阳性球菌有效的抗生素万古霉素或替考拉宁，并更换β-内酰胺类抗生素。如果治疗7天后仍存在微生物学上未明确的感染，则需使用两性霉素B进行经验性抗真菌治疗。经验性抗生素治疗的持续时间取决于粒细胞的恢复情况及感染的消退情况。
