Abstract
Most patients (85Â %) receiving empirical antibiotic therapy for febrile neutropenia (FN) will promptly respond with defervescence, especially if predicted at a low risk of complications. The absence of response can be due to resistance of the bacteria or overwhelming bacterial sepsis (especially in non-low-risk patients); these situations pose little diagnostic challenge. The possibility of a noninfectious cause for persistent fever (e.g, embolism, drug fever) might be more problematic, although it is a relatively rare event.
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References
Klastersky J, Paesmans M. Antifungal therapy in febrile neutropenic patients: review of treatment choices and strategies for aspergillar infection. Support Care Cancer. 2007;15:137-141.
Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med. 1982;72:101-111.
European Organisation for Research and Treatment of Cancer, International Antimicrobial Therapy Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med. 1989;86:668-672.
Guiot HFL, Fibbe WE, Van’t Wout JW. Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis. Clin Infect Dis. 1994;18:525-532.
Corey L, Boeckh M. Persistent fever in patients with neutropenia. N Engl J Med. 2002;346:222-224.
Maertens J, Theunissen K, Verhoef G, et al. Galactomannan and computed tomographybased preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study. Clin Infect Dis. 2005;41:1242-1250.
Ascioglu S, Rex JH, de Pauw B, et al; Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer; Mycoses Study Group of the National Institute of Allergy and Infectious Diseases. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 2002;34:7-14.
Cuenca-Estrella M, Meije Y, Diaz-Pedroche C, et al. Value of serial quantification of fungal DNA by a real-time PCR-based technique for early diagnosis of invasive aspergillosis in patients with febrile neutropenia. J Clin Microbiol. 2009;47:379-384.
Riedel A, Choe L, Inciardi J, Yuen C, Martin T, Guglielmo BJ. Antifungal prophylaxis in chemotherapy-associated neutropenia: a restrospective, observational study. BMC Infect Dis. 2007;7:70.
Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348-359.
Pagano L, Caira M, Cuenca-Estrella M. The management of febrile neutropenia in the posaconazole era: a new challenge? Haematologica. 2012;97:963-965.
Michallet M, Sobh M, Morisset S, et al. Risk factors for invasive aspergillosis in acute myeloid leukemia patients prophylactically treated with posaconazole. Med Mycol. 2011;49:681-687.
Candoni A, Simeone E, Caira M, Mazzuzzo M, Fanin R, Pagano L. Prophylaxis of invasive fungal diseases with posaconazole in acute myeloid leukemia. A real life experience. Abstract O804 at 16th EHA (European Hematology Association) Congress; June 11, 2011.
Lerolle N, Lafaurie M, Touratier S, et al. Breakthrough invasive fungal infections in patients with hematological cancers receiving posaconazole prophylaxis: a four-year study. Abstract M-1521 ICAAC; Chicago. Sept. 2011.
Egerer G, Geist MJ. Posaconazole prophylaxis in patients with acute myelogenous leukaemia--results from an observational study. Mycoses. 2011;54(Suppl 1):7-11.
Vehreschild JJ, Rüping MJ, Wisplinghoff H, et al. Clinical effectiveness of posaconazole prophylaxis in patients with acute myelogenous leukaemia: a 6 year experience of the Cologne AML cohort. J Antimicrob Chemother. 2010;65:1466-1471.
Hahn J, Stifel F, Reichle A, Holler E, Andreesen R. Clinical experience with posaconazole prophylaxis--a retrospective analysis in a haematological unit. Mycoses. 2011;54(Suppl 1):12-16.
Busca A, Frairia C, Marmont F, et al. Posaconazole vs standard azoles for prevention of invasive fungal infections in patients with acute myeloid leukemia. Poster P088 at 5th TIMM (Trends in Medical Mycology) Congress; Valencia. Oct 2–5, 2011.
Ananda-Rajah MR, Grigg A, Downey MT, et al. Comparative clinical effectiveness of prophylactic voriconazole/posaconazole to fluconazole/itraconazole in patients with acute myeloid leukaemia/myelodysplastic syndrome undergoing cytotoxic chemotherapy over a 12-year period. Haematologica. 2012;97:459-463.
Klastersky J. Antifungal therapy in patients with fever and neutropenia – More rational and less empirical? N Engl J Med. 2004;351:1445-1447.
Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med. 1999;340:764-771.
Walsh TJ, Pappas P, Winston DJ, et al; National Institute of Allergy and Infectious Diseases Mycoses Study Group. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med. 2002;346:225-234.
Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med. 2004;351:1391-1402.
Maertens J, Deeren D, Dierickx D, Theunissen K. Preemptive antifungal therapy: still a way to go. Curr Opin Infect Dis. 2006;19:551-556.
Cordonnier C, Pautas C, Maury S, et al. Empirical versus antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis. 2009;48:1042-1051.
Rieger CT, Ostermann H. Empiric vs preemptive antifungal treatment: an appraisal of treatment strategies in haematological patients. Mycoses. 2008;51:(Suppl 1):31-34.
Herbrecht R, Caillot D, Cordonnier C, et al. Indications and outcomes of antifungal therapy in French patients with haematological conditions or recipients of haematopoietic stem cell transplantation. J Antimicrob Chemother. 2012;67:2731-2738.
Kanji JN, Laverdière M, Rotstein C, Walsh TJ, Shah PS, Haider S. Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials. Leuk Lymphoma. 2013;54:1479-1487.
Walsh TJ, Anaissie EJ, Denning DW, et al; Infectious Diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:327-360.
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Klastersky, J.A. (2014). Management of Persistent Fever in Patients with Neutropenia Despite Empirical Antibiotic Administration. In: Febrile Neutropenia. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-907673-70-2_6
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DOI: https://doi.org/10.1007/978-1-907673-70-2_6
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