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Updated: Oct 2, 2026
Neutrophil Isolation and Analysis to Determine their Role in Lymphoma Cell Sensitivity to Therapeutic Agents
Published on: March 25, 2016
[From epidemiology to therapeutic choices. Infections in patients with neutropenia]
C Cordonnier1, N Dhedin, C Rieux
1Service d'Hématologie clinique, Hôpital Henri Mondor, Créteil.
Abstract:
CHANGING EPIDEMIOLOGY: In hermtology units, Gram positive germs are becoming more predominate than Gram negative germs for reasons related both to changing clinical practices and to the epidemiology of infectious diseases. Nevertheless, mortality due to Gram negative germs, particularly Pseudomonas, remains high and justifies continued application of a rule established more than 20 years ago concerning the requirement, in neutropenic patients, to aim antibiotics against the most eminetly dangerous germs. FOR HIGH RISK PATIENTS: Patients with severe prolonged neutropenia, the betalactam-aminoglycoside combination is still indicated in most cases due to its spectrum, bacteriocidal rate and synergetic action. According to the most recent randomized trials, adding a first intention glycopeptide, except in specific situations (suspected infected catheter, high incidence of methicillin-resistant Staphylococcus aureus), would not be justified. FOR LOW RISK PATIENTS: Single drug regimens are still indicated if a wide spectrum compound is used, especially for Gram negative germs. Several trials in outpatients have been attempted, but patients selection criteria remain to be defined. WHICH ANTIBIOTIC? Choosing the right antibiotic, for both high-risk and low-risk patients, requires knowledge of the causal germs generally encountered in the unit. The choice may vary over time depending on germ ecology within the unit and whether an in- or out-patient is to be treated.
Insights
Gram-positive bacteria are increasingly common in hematology units, but Gram-negative infections, especially Pseudomonas, still cause high mortality. Antibiotic choices for neutropenic patients depend on risk factors and local germ prevalence.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Microbiology
Context:
- Evolving epidemiology of bloodstream infections in hematology units.
- Increasing prevalence of Gram-positive organisms.
- Persistent high mortality from Gram-negative infections, particularly Pseudomonas.
Purpose:
- To provide updated guidance on antibiotic selection for neutropenic patients in hematology.
- To address the changing landscape of bacterial epidemiology.
- To optimize treatment strategies based on patient risk stratification.
Summary:
- For high-risk neutropenic patients, betalactam-aminoglycoside combinations remain a primary choice due to broad spectrum and synergy. Adding glycopeptides is generally not recommended unless specific risk factors are present.
- For low-risk neutropenic patients, single-agent, broad-spectrum antibiotics are indicated, particularly targeting Gram-negative bacteria.
- Antibiotic selection requires knowledge of local microbial ecology and should be tailored to individual patient risk, considering both inpatient and outpatient settings.
Impact:
- Informs clinical practice for antibiotic stewardship in hematology.
- Aims to reduce mortality associated with Gram-negative infections in neutropenic patients.
- Highlights the importance of adapting treatment guidelines to changing epidemiological trends.
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