Infections in the Neutropenic Patient— New Views of an Old Problem

Abstract

Infection in the neutropenic patient has remained a major clinical challenge for over three decades. While diagnostic and therapeutic interventions have improved greatly during this period, increases in the number of patients with neutropenia, changes in the etiologic agents involved, and growing antibiotic resistance have continued to be problematic.The evolving etiology of infections in this patient population is reviewed by Dr. Donowitz. Presently accepted antibiotic regimens and practices are discussed, along with ongoing controversies.In Section II, Drs. Maki and Crnich discuss linerelated infection, which is a major infectious source in the neutropenic. Defining true line-related bloodstream infection remains a challenge despite the fact that various methods to do so exist. Means of prevention of line related infection, diagnosis, and therapy are reviewed.Fungal infection continues to perplex the infectious disease clinician and hematologist/ oncologist. Diagnosis is difficult, and many fungal infections will lead to increased mortality even with rapid diagnosis and therapy. In Section III, Dr. Pappas reviews the major fungal etiologies of infection in the neutropenic patient and the new anti-fungals that are available to treat them.Finally, Dr. Rolston reviews the possibility of outpatient management of neutropenic fever. Recognizing that neutropenics represent a heterogeneous group of patients, identification of who can be treated as an outpatient and with what antibiotics are discussed.

Continuous infusion of amphotericin B: preliminary experience at Faculdade de Medicina da Fundação ABC

“…Recently, other antifungal drugs, such as new triazoles and caspofungin, have emerged as promising agents for the prevention of invasive fungal infections in persistently febrile neutropenic patients. [2][3][4] In fact, in a comparative trial, voriconazole, a second-generation triazole, proved to be a suitable alternative to amphotericin B preparations. 4 The major inconvenience of these new antifungal drugs, however, is their higher cost, which may seriously hamper their use in underdeveloped countries.…”

“…In fact, amphotericin B deoxycholate (AmB-D) in the setting of persistent fever in neutropenic patients reduces the relative risk for documented invasive fungal infections by 50% to 80% and the overall mortality rate by 23% to 45%. 2 The use of AmB-D in these patients is, however, limited by the frequent induction of nephrotoxicity and by the undesirable infusion-related side effects such as fever, rigors and chills. Because of this adverse toxicity profile, AmB-D has been compared unfavorably with new amphotericin formulations and other antifungal drugs.…”

“…Because of this adverse toxicity profile, AmB-D has been compared unfavorably with new amphotericin formulations and other antifungal drugs. 2 In the late 1990s, liposomal amphotericin B (L-AmB) emerged as a new option for the treatment for persistent fever in neutropenic patients by reducing the frequency of proven breakthrough fungal infections, with lower infusion-related toxic reactions and also reduced nephrotoxicity, [2][3][4] in comparison with AmB-D. Recently, other antifungal drugs, such as new triazoles and caspofungin, have emerged as promising agents for the prevention of invasive fungal infections in persistently febrile neutropenic patients.…”

“…the use of steroids or lymphoid malignancies). 2 In the early 1980s, many trials drew attention to the empirical and prophylactic application of antifungal drugs within such a scenario. In fact, amphotericin B deoxycholate (AmB-D) in the setting of persistent fever in neutropenic patients reduces the relative risk for documented invasive fungal infections by 50% to 80% and the overall mortality rate by 23% to 45%.…”

Microbial Pattern and Antibiotic Sensitivity Test of Hospitalized Children

“…Neutropenia can be caused by bone marrow suppression due to malignant disease or chemotherapy. Malignancy in patients with impaired immunity can occur so that children with malignancies susceptible to infection (Hermawati 2011, Rena et al 2010, Donowitz et al 2001, Danai et al 2006.…”