医学
发热性中性粒细胞减少症
重症监护医学
中止
他唑巴坦
中性粒细胞减少症
抗菌管理
抗菌剂
替加环素
哌拉西林/他唑巴坦
抗生素
降级
内科学
哌拉西林
抗生素耐药性
化疗
铜绿假单胞菌
微生物学
生物
亚胺培南
细菌
遗传学
作者
Martin Schmidt‐Hieber,Daniel Teschner,Georg Maschmeyer,Enrico Schalk
标识
DOI:10.1080/14787210.2019.1573670
摘要
Introduction: Infections are among the most frequent complications in patients with hematological and oncological diseases. They might be classified as fever of unknown origin and microbiologically or clinically documented infections. Optimal duration of antimicrobial treatment is still unclear in these patients.Areas covered: We provide an overview on the management of febrile neutropenia in the perspective of antimicrobial de-escalation and discontinuation.Expert opinion: Patients with febrile high-risk neutropenia should be treated empirically with an anti-pseudomonal agent such as piperacillin/tazobactam. Several clinical studies support the assumption that the primary antibiotic regimen might be safely discontinued prior to neutrophil reconstitution if the patient is afebrile for several days and all infection-related symptoms have been resolved. Primary empirical treatment with carbapenems or antibiotic combinations should commonly only be considered in selected patient subgroups, such as patients with severe neutropenic sepsis or colonization with multidrug-resistant bacteria. Preemptive antifungal treatment guided by lung imaging and other parameters (e.g. serial Aspergillus galactomannan antigen screening) might reduce the consumption of antifungals compared to the classical empirical approach.Multidrug-resistant pathogens are emerging, and novel anti-infective agents under development are scarce. Therefore, a rational use of antimicrobials based on the principles of antibiotic stewardship is crucial.
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