The strategy of antibiotic use in critically ill neutropenic patients

doi:10.1186/2110-5820-1-22

. 2011 Jun 15;1(1):22.

doi: 10.1186/2110-5820-1-22.

The strategy of antibiotic use in critically ill neutropenic patients

Matthieu Legrand¹, Adeline Max, Benoît Schlemmer, Elie Azoulay, Bertrand Gachot

Affiliations

PMID: 21906359
PMCID: PMC3224396
DOI: 10.1186/2110-5820-1-22

The strategy of antibiotic use in critically ill neutropenic patients

Matthieu Legrand et al. Ann Intensive Care. 2011.

. 2011 Jun 15;1(1):22.

doi: 10.1186/2110-5820-1-22.

Authors

Matthieu Legrand¹, Adeline Max, Benoît Schlemmer, Elie Azoulay, Bertrand Gachot

Affiliation

¹ Department of Intensive Care and Infectious Diseases, Institut Gustave Roussy, 39, rue Camille Desmoulins, 94805 Villejuif cedex, France. gachot@igr.fr.

PMID: 21906359
PMCID: PMC3224396
DOI: 10.1186/2110-5820-1-22

Abstract

Suspicion of sepsis in neutropenic patients requires immediate antimicrobial treatment. The initial regimen in critically ill patients should cover both Gram-positive and Gram-negative pathogens, including Pseudomonas aeruginosa. However, the risk of selecting multidrug-resistant pathogens should be considered when using broad-spectrum antibiotics for a prolonged period of time. The choice of the first-line empirical drugs should take into account the underlying malignancy, local bacterial ecology, clinical presentation and severity of acute illness. This review provides an up-to-date guide that will assist physicians in choosing the best strategy regarding the use of antibiotics in neutropenic patients, with a special focus on critically ill patients, based on the above-mentioned considerations and on the most recent international guidelines and literature.

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Figures

**Figure 1**
**Suggested adjustments to the empirical antibiotic regimen in patients with persistent fever after 3-5 days treatment**.

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References

1. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–751. doi: 10.1086/339215. - DOI - PubMed
1. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clin Infect Dis. Vol. 52. 2010 update of the Infectious Diseases Society of America; 2011. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer; pp. e56–e59. - DOI - PubMed
1. Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–696. doi: 10.1097/CCM.0B013E318165314B. - DOI - PubMed
1. Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005;23:4406–4413. doi: 10.1200/JCO.2005.01.487. - DOI - PubMed
1. Buchheidt D, Bohme A, Cornely OA, Fatkenheuer G, Fuhr HG, Heussel G, Junghanss C, Karthaus M, Kellner O, Kern WV, Schiel X, Sezer O, Sudhoff T, Szelenyi H. Diagnosis and treatment of documented infections in neutropenic patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Ann Hematol. 2003;82(Suppl 2):S127–S132. - PubMed

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[1] Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–751. doi: 10.1086/339215. - DOI - PubMed

[2] Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–751. doi: 10.1086/339215. - DOI - PubMed

[3] Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clin Infect Dis. Vol. 52. 2010 update of the Infectious Diseases Society of America; 2011. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer; pp. e56–e59. - DOI - PubMed

[4] Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America. Clin Infect Dis. Vol. 52. 2010 update of the Infectious Diseases Society of America; 2011. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer; pp. e56–e59. - DOI - PubMed

[5] Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–696. doi: 10.1097/CCM.0B013E318165314B. - DOI - PubMed

[6] Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–696. doi: 10.1097/CCM.0B013E318165314B. - DOI - PubMed

[7] Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005;23:4406–4413. doi: 10.1200/JCO.2005.01.487. - DOI - PubMed

[8] Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005;23:4406–4413. doi: 10.1200/JCO.2005.01.487. - DOI - PubMed

[9] Buchheidt D, Bohme A, Cornely OA, Fatkenheuer G, Fuhr HG, Heussel G, Junghanss C, Karthaus M, Kellner O, Kern WV, Schiel X, Sezer O, Sudhoff T, Szelenyi H. Diagnosis and treatment of documented infections in neutropenic patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Ann Hematol. 2003;82(Suppl 2):S127–S132. - PubMed

[10] Buchheidt D, Bohme A, Cornely OA, Fatkenheuer G, Fuhr HG, Heussel G, Junghanss C, Karthaus M, Kellner O, Kern WV, Schiel X, Sezer O, Sudhoff T, Szelenyi H. Diagnosis and treatment of documented infections in neutropenic patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Ann Hematol. 2003;82(Suppl 2):S127–S132. - PubMed

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The strategy of antibiotic use in critically ill neutropenic patients

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The strategy of antibiotic use in critically ill neutropenic patients

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