Summary
The impact of a standardized set of diagnostic interventions on the further management of 968 episodes of fever in neutropenic cancer patients who did not respond to initial therapy was assessed prospectively. At the onset of fever, 65% of patients had no additional signs of infection, whereas skin and soft tissue infections were present in 12% and clinical sepsis and gastrointestinal infections in 8% each. After 72h, 41% of the fevers still remained unexplained. New foci of infection emerged in 11% of the cases involving mainly the lungs, skin and soft tissues, and urinary tract. The presence of a lower respiratory tract infection or a microbiologically defined infection of any sort was associated with higher mortality than other types of infection were. Changes in initial antibiotic therapy were, based on the results of the diagnostic measures specified in the protocol in only 15% of the cases.
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Schimpff, S. C., Satterlee, W., Young, V. M., Serpick, A.: Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N. Engl. J. Med. 284 (1971) 1061–1065.
Pizzo, P. A., Robichaud, K. J., Wesley, R., Commers, J. R.: Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine 61 (1982) 153–165.
The EORTC International Antimicrobial Therapy Cooperative Group and National Cancer Institute of Canada: Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic patients. J. Infect. Dis. 163 (1991) 951–958.
Schimpff, S. C.: An overview of empiric antibiotic therapy for the febrile neutropenic patient. Rev. Infect. Dis. 7 (Suppl. 4) (1985) S734-S740.
De Pauw, B. E., Deresinski, S. C., Feld, R., Lane-Allman, E. F., Donnelly J. P.: Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer—a multicenter randomized trial. Ann. Intern. Med. 120 (1994) 834–844.
De Pauw, B. E., Donnelly, J. P., Elves, A., Verhagen, C., Nováková, I. R. O. Van der Meer, J. W. M.: Towards individually tailored empiric antibiotic therapy in febrile granulocytopenic patients. Neth. J. Med. 37 (1990) 111–119.
Sickles, E. A., Greene, W. H., Wiernik, P. H.: Clinical presentation of infection in granulocytopenic patients. Arch. Intern. Med. 135 (1975) 715–719.
Donnelly, J. P., Nováková, I. R. O., Raemaekers, J. M. M., De Pauw, B. E.: Empiric treatment of localized infections in febrile neutropenic patients with monotherapy. Leuk. Lymphoma 9 (1993) 193–203.
Fainstein, V., Bodey, G. P., Elting, L., Bolivar, R., Keating, M. J., McCredie, K. B., Valdivieso, M.: A randomized study of ceftazidime compared to ceftazidime and tobramycin for the treatment of infections in cancer patients. J. Antimicrob. Chemother. 12 (1983) 101–110.
Pizzo, P. A., Hathorn, J. W., Hiemenz, J., Browne, M., Commers, J., Cotton, D., Gress, J., Longo, D., Marshall, D., McKnight, J., Rubin, M., Skelton, J., Thaler, M., Wesley, R.: A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N. Engl. J. Med. 315 (1986) 552–558.
Bodey, G. P., Fainstein, V., Elting, L. S., Anaissie, E., Rolston, K., Khardori, N., Kantarjian, H., Plager, C., Murphy, W. K., Holmes, F., Cabanillas, F.: β-Lactam regimens for the febrile neutropenic patient. Cancer 65 (1990) 9–16.
Rolston, K. V. I., Berkey, P., Bodey, G. P., Anaissie, E., Khardori, N. M., Joshi, J. H., Keating, M. J., Holmes, F. A., Cabanillas, F. F., Elting, L.: A comparison of imipenem to ceftazidime with and without amikacin as empiric therapy in febrile neutropenic patients. Arch. Intern. Med. 152 (1992) 283–291.
Jochelson, M. S., Altschuler, J., Stomper, P. C.: The yield of chest radiography in febrile and neutropenic patients. Ann. Intern. Med. 105 (1986) 708–709.
Feusner, J., Cohen, R., O'Leary, M., Beach, B.: Use of routine chest radiography in the evaluation of fever in neutropenic pediatric oncology patients. J. Clin. Oncol. 6 (1988) 1699–1702.
Stover, D. E., Zaman, M. B., Hajdu, S. I., Lange, M., Gold, J., Armstrong, D.: Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann. Intern. Med. 101 (1984) 1–7.
Kuhlman, J. E., Fishman, E. K., Siegelman, S. S.: Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 157 (1985) 611–614.
Caillot, D., Casasnovas, O., Bernard, A., Couaillier, J.-F., Durant, C., Cuisenier, B., Solary, E., Pirard, F., Petrella, T., Bonnin, A., Couillaut, G., Dumas, M., Guy, H.: Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J. Clin. Oncol. 15 (1997) 139–147.
Ramphal, R., Bolger, M., Oblon, D. J., Sherertz, R. J., Malone, J. D., Rand, R. H., Gilliom, M., Shands, J. W., Kramer, B. S.: Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime—a randomized prospective study. Antimicrob. Agents Chemother. 36 (1992) 1062–1067.
O'Hanley, P., Easaw, J., Rugo, H., Easaw, S.: Infectious disease management of adult leukemic patients undergoing chemotherapy: 1982 to 1986 experience at Standford University Hospital. Am. J. Med. 87 (1989) 605–613.
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Dompeling, E.C., Donnelly, J.P., Raemaekers, J.M.M. et al. Evolution of the clinical manifestations of infection during the course of febrile neutropenia in patients with malignancy. Infection 26, 349–354 (1998). https://doi.org/10.1007/BF02770834
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DOI: https://doi.org/10.1007/BF02770834