This article, prepared by the Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guidelines Panel, updates guidelines established a decade ago by the Infectious Disease Society of America for the use of antimicrobial agents to treat neutropenic patients with unexplained fever [1]. DefinitionsFever is defined as a single oral temperature of у38.3ЊC (101ЊF) or a temperature of у38.0ЊC (100.4ЊF) for у1 h. Neutropenia is defined as a neutrophil count of !500 cells/mm 3 , or a count of !1000 cells/mm 3 with a predicted decrease to !500 cells/mm 3 . Initial EvaluationDetermine whether the patient is at low risk for complications; determine whether vancomycin therapy is needed. Initial Antibiotic TherapyOral route. For low-risk adults only; use ciprofloxacin plus amoxicillin-clavulanate.Monotherapy with vancomycin not indicated.

This is the first in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are internists, pediatricians, and family practitioners. The targeted patients and setting for the fever and neutropenia guideline are hospitalized individuals with neutropenia secondary to cancer chemotherapy. Panel members represented experts in adult and pediatric infectious diseases and oncology. The guidelines are evidence-based. A standard ranking system was used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary, algorithms, and tables highlight the major recommendations. The guideline will be listed on the IDSA home page at http://www.idsociety.org.

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A hemagglutination (HA) typing system has been developed for demonstrating and characterizing the mannose-sensitive and mannose-resistant hemagglutinins produced by Escherichia coli isolated from human sources. HA typing is performed by testing CFA agar-grown E. coli cells for HA with human, bovine, adult chicken, African Green monkey, and guinea pig erythrocytes in the presence and absence of mannose. Seven major HA types, designated HA type I through HA type VII, have been defined according to the HA patterns produced by 1,334 test cultures consisting of 33 colonization factor antigen I (CFA/I)-positive enterotoxigenic E. coli (ETEC), 37 CFA/II-positive ETEC, 614 isolates belonging to the classical enteropathogenic E. coli, or EPEC, serogroups, 446 non-ETEC, non-EPEC stool isolates, and 204 bacteremia-associated E. coli. Facultatively enteropathogenic E. coli (FEEC) serogroups, which are the causative agents of extraintestinal infections but also sporadic cases of enteritis, comprised 38% of the stool isolates and 91% of the blood isolates examined. Previous observations concerning the HA patterns of CFA-positive ETEC and the EPEC were confirmed. A significant correlation was found between FEEC serogroups and the production of mannose-resistant HA with human, monkey, and usually chicken erythrocytes (the HA patterns designated HA type VI). A large majority (80.2%) of the FEEC strains belonging to the most frequently isolated serogroups from cases of bacteremia (01, 02, 04, 06, 07, and 018) produced type VI HA patterns. Stool isolates belonging to these same serogroups were 59.2% positive for HA type VI patterns. In contrast, only 17.4% of the non-FEEC stool isolates and 1.9% of the EPEC isolates belong to HA type VI. Of the blood isolates, the HA type VI phenotype

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A B S T R A C T Serum antibodies to exotoxin A and type-specific lipopolysaccharide were measured by passive hemagglutination in 52 patients with Pseudomonas aeruginosa septicemia. Their comparative protective activities were evaluated by relating the titers of each at the onset of bacteremia to subsequent outcome. High acute serum antitoxin and antilipopolysaccharide titers (log2 reciprocal mean titers >5) were associated with survival (76% of 17 with high vs. 46% of 24 with low antitoxin titers, P = 0.05; 85% of 13 with high vs. 48% of29 with low antilipopolysaccharide titers, P = 0.03). In contrast, neither antibody titer was significantly associated (P c 0.05) with patients' age or sex, severity ofunderlying disease, presence ofleukopenia, steroid or immunosuppressive therapy. Despite a correlation between acute titers of the two antibodies (r = 0.33, P = 0.06), they appeared to protect independently and additively. Whereas 75% of 8 patients with high antitoxin titers and only 38% of 16 with low titers survived with low antilipopolysaccharide titers (P = 0.10), 100% (6/6), 73% (8/11), and 38% (6/16) survived, respectively, when both, one, or neither antibody was present in high titer (P = 0.01). Furthermore, the association between high acute serum antitoxin titers and survival was more pronounced in patients with rapidly fatal underlying disease (P = 0.06) and leukopenia (P = 0.12) than in more favorable prognostic and immune categories. These data indicate that serum antibodies to exotoxin A and lipopolysaccharide are found in most patients with P. aeruginosa septicemiaThe opinions and assertions contained herein are the private ones of the writers and are not to be construed as official or reflecting the views of the Navy Department or the naval service at large.