TY  - CHAP
M1  - Book, Section
TI  - Approach to Infection in Patients Receiving Cytotoxic Chemotherapy for Malignancy
A1  - Bow, E.J.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
A2  - Douglas, Ivor S.
Y1  - 2023
N1  - 
T2  - Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
AB  - KEY  POINTSRisk  of  infection  increases  as  the  circulating  absolute  neutrophil  count  (ANC)  declines  below  1.0  and  0.5  ×  109/L.  The  greatest  risk  of  bacteremic  infection  occurs  when  the  ANC    0.5  ×  109/L)  can  vary  from  21  to  42  days.Intermittent  administration  of  cytotoxic  therapy  for  solid  tissue  malignancies  or  lymphoreticular  malignancies  (low-risk  patients)  is  often  associated  with  a  neutrophil  nadir  at  10  to  14  days  from  beginning  treatment  and  with  periods  of  neutropenia  (ANC  <  0.5  ×  109/L)  of  less  than  5  to  7  days.  This  pattern  of  neutrophil  recovery  influences  the  natural  history  of  febrile  neutropenic  episodes.Febrile  episodes  during  neutropenia  are  defined  by  an  oral  temperature  of  ≥38.3°C  (100°F)  in  the  absence  of  other  noninfectious  causes  of  fever  such  as  administration  of  blood  products  or  pyrogenic  drugs  (eg,  cytotoxic  therapy,  amphotericin  B),  the  underlying  disease,  thromboembolic  or  thrombophlebitic  events,  or  hemorrhagic  events.A  single  neutropenic  episode  may  be  characterized  by  one  or  more  febrile  episodes,  of  which  one  or  more  may  represent  infections.Body  sites  most  often  associated  with  infection  in  the  neutropenic  patient  are  those  associated  with  integumental  surfaces  (skin,  upper  and  lower  respiratory  tract,  and  upper  and  lower  gastrointestinal  tract).Antibacterial  prophylaxis  with  oral  fluoroquinolone  agents  such  as  ciprofloxacin  or  levofloxacin  can  reduce  the  frequency  of  febrile  episodes  and  bacteremic  events  in  patients  with  protracted  neutropenia.Patients  undergoing  remission-induction  for  acute  myeloid  leukemia  or  bone  marrow  transplantation  with  a  history  of  herpetic  stomatitis  or  who  are  IgG-seropositive  for  herpes  simplex  virus  (HSV)  are  at  risk  for  severe  herpetic  mucositis.  Such  patients  should  be  considered  for  oral  nucleoside  analogue-based  acyclovir  antiviral  prophylaxis.The  recommended  initial  empirical  antibacterial  therapy  for  suspected  infection  in  the  febrile  neutropenic  patient  is  a  broad-spectrum  antibacterial  regimen  of  an  antipseudomonal  penicillin  or  carbapenem  administered  as  a  single  agent  (monotherapy).  Additional  initial  antibacterial  agents  such  as  the  aminoglycosides,  fluoroquinolones,  or  vancomycin  may  be  indicated  for  the  initial  management  of  severe  sepsis/septic  shock,  pneumonia,  or  where  antimicrobial  resistance  is  suspected.The  median  time-to-defervescence  for  febrile  neutropenic  patients  at  low  and  high  risk  for  medical  complications  is  3  and  5  days,  respectively.  Immune  augmenting  anticancer  therapies  such  as  chimeric  antigen  receptor  T-cells  (CAR-T)  or  the  checkpoint  inhibitors  may  generate  T-lymphocyte-mediated  sepsis-like  syndromes  that  require  immune  suppression  to  control.  Infection  risk  is  enhanced  by  the  immune  suppressive  therapy.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/10/12
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1201805530
ER  -