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Published on: June 2, 2011
Infections in the neutropenic patient--new views of an old problem
G R Donowitz1, D G Maki, C J Crnich
1University of Virginia Health System, Charlottesville 22908-1343, USA.
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 line-related 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.
Insights
Infections in neutropenic patients remain a challenge due to rising numbers, evolving pathogens, and antibiotic resistance. This review covers infection etiology, line-related infections, fungal infections, and outpatient management strategies for neutropenic fever.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Infection in neutropenic patients is a persistent clinical challenge.
- Despite advances, increased neutropenia cases, changing pathogens, and antibiotic resistance complicate management.
- Neutropenic patients face significant risks from various infections.
Purpose of the Study:
- To review the evolving etiology of infections in neutropenic patients.
- To discuss current antibiotic regimens, controversies, and line-related infections.
- To explore fungal infections and potential outpatient management of neutropenic fever.
Main Methods:
- Literature review of infection etiology in neutropenic patients.
- Discussion of diagnostic and therapeutic strategies for line-related infections.
- Review of fungal infections and emerging antifungal agents.
- Analysis of criteria for outpatient management of neutropenic fever.
Main Results:
- Infection etiology in neutropenic patients is dynamic and challenging.
- Line-related infections are a significant source, with diagnostic challenges persisting.
- Fungal infections pose a high mortality risk, necessitating new diagnostic and therapeutic approaches.
- Outpatient management of neutropenic fever is feasible for select patients.
Conclusions:
- Effective management of neutropenic infections requires addressing evolving etiologies and resistance.
- Improved diagnostics and targeted therapies are crucial for line-related and fungal infections.
- Careful patient selection and antibiotic choice are key for successful outpatient management of neutropenic fever.
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