Skip to main content
SpringerLink
Log in

Introduction: Approach to the Patient

  • Chapter
  • First Online:
Managing Infections in Patients With Hematological Malignancies

Part of the book series: Contemporary Hematology ((CH))

  • 633 Accesses

Abstract

The empirical treatment of febrile neutropenic patients with suspected infections is one of the true success stories in the supportive care of patients with hematological malignancies. The essence of the febrile neutropenia paradigm is the shift of focus from microbial pathogens to the immune deficiencies of the host: immune deficiencies intrinsic to the underlying malignancies themselves and to the therapies employed to treat them. The impact of immune dysfunction can be best understood in terms of assessments of risks and likelihoods: the risks of acquiring a particular infection and the likelihoods of achieving a successful outcome if infected. The risks of prolonged neutropenia associated with treatment of acute leukemia are probably the best known to hematologists and infectious diseases specialists because of a long record of groundbreaking studies published over the last 50 years. The lessons learned have been applied to other patients with different immune defects, such as recipients of allogeneic stem cell transplants. There have been many reviews, chapters, position papers from professional societies, etc. over the years, promoting various guidelines for the general approach to managing infections in patients with hematological malignancies. However, experienced clinicians know that these guidelines, irrespective of their origins, are merely stepping stones to the initial approach to the potentially infected patient. There is no substitute for standing at the patient’s bedside. The goal should be to individualize therapy based on the generic paradigm, taking into account unique features in any patient’s situation that might optimize the condition for success and diminish the risks of failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McCabe WR, Jackson GG (1962) Gram-negative bacteremia: II. Clinical, laboratory, and therapeutic observations. Arch Intern Med 110:856–864

    Google Scholar 

  2. Schimpff SC, Gaya H, Klastersky J et al (1978) Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer: the EORTC international antimicrobial therapy project group. J Infect Dis 137:14–29

    Article  PubMed  CAS  Google Scholar 

  3. Bow EJ (2003) Infectious complications in patients receiving cytotoxic therapy for acute leukemia: history, background and approaches to management. In: Wingard JR, Bowden RA (eds) Management of Infection in Oncology Patients. Martin Dunitz, London, pp 71–104

    Google Scholar 

  4. (2000) Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 6:659–713

    Google Scholar 

  5. Bodey GP, Buckley M, Sathe YS, Freireich EJ (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–40

    PubMed  CAS  Google Scholar 

  6. Bodey GP, Rodriguez V, Chang HY, Narboni G (1978) Fever and infection in leukemic patients: a study of 494 consecutive patients. Cancer 41:1610–22

    Article  PubMed  CAS  Google Scholar 

  7. Bodey GP (1997) The treatment of febrile neutropenia: from the Dark Ages to the present. Support Care Cancer 5:351–7

    Article  PubMed  CAS  Google Scholar 

  8. Curtin JA, Marshall BD Jr (1962) Use of antibiotics in cancer and leukemia. J Chronic Dis 15:713–8

    Article  PubMed  CAS  Google Scholar 

  9. Schimpff SC, Satterlee W, Young VM, Serpick A (1971) Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 284:1061–5

    Article  PubMed  CAS  Google Scholar 

  10. Schimpff SC, Young VM, Greene WH, Vermeulen GD, Moody MR, Wiernik PH (1972) Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens. Ann Intern Med 77:707–14

    PubMed  CAS  Google Scholar 

  11. Bow EJ (2005) Management of the febrile neutropenic cancer patient: lessons from 40 years of study. Clin Microbiol Infect 11(Suppl 5):24–9

    Article  PubMed  Google Scholar 

  12. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG, Levine AS, Deisseroth AB et al (1979) Duration of empiric antibiotic therapy in granulocytopenic patients with cancer. Am J Med 67:194–200

    Article  PubMed  CAS  Google Scholar 

  13. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–51

    Article  PubMed  Google Scholar 

  14. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG (1982) Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 72:101–11

    Article  PubMed  CAS  Google Scholar 

  15. EORTC International Antimicrobial Therapy Project Group (1989). Empiric antifungal therapy in febrile granulocytopenic patients. EORTC International Antimicrobial Therapy Cooperative Group. Am J Med 86:668–672

    Google Scholar 

  16. Link H, Bohme A, Cornely OA, Hoffken K, Kellner O, Kern WV et al (2003) Antimicrobial therapy of unexplained fever in neutropenic patients – guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society). Ann Hematol 82(Suppl 2):S105–S117

    Article  PubMed  CAS  Google Scholar 

  17. Freifeld AG, Baden LR, Brown AE, Elting L, Gelfand M, Greene JN et al (2004) Fever and neutropenia. J Natl Compr Canc Netw 2:390–432

    PubMed  Google Scholar 

  18. Santolaya ME, Rabagliati R, Bidart T, Paya E, Guzman AM, Morales R et al (2005) Consensus: rational approach towards the patient with cancer, fever and neutropenia. Rev Chilena Infectol 22(Suppl 2):S79–113

    PubMed  Google Scholar 

  19. Garcia-Rodriguez JA, Gobernado M, Gomis M, Mensa J, Picazo J, Prieto J et al (2001) Clinical guide for the evaluation and treatment of patients with neutropenia and fever. Rev Esp Quimioter 14:75–83

    PubMed  CAS  Google Scholar 

  20. Guidelines for the use of antimicrobial agents in patients with febrile neutropenia in Taiwan (2005). J Microbiol Immunol Infect 38:455–457

    Google Scholar 

  21. Masaoka T (2000) Febrile neutropenia – guideline in Japan. Gan To Kagaku Ryoho 27:161–5

    PubMed  CAS  Google Scholar 

  22. Masaoka T (2004) Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary. Clin Infect Dis 39(Suppl 1):S49–S52

    Article  PubMed  Google Scholar 

  23. Wade JC, Glasmacher A (2004) Vancomycin does not benefit persistently febrile neutropenic people with cancer. Cancer Treat Rev 30:119–26

    Article  PubMed  Google Scholar 

  24. Kern WV (2001) Risk assessment and risk-based therapeutic strategies in febrile neutropenia. Curr Opin Infect Dis 14:415–22

    PubMed  CAS  Google Scholar 

  25. Rolston KV (1998) Risk assessment and risk-based therapy in febrile neutropenic patients. Eur J Clin Microbiol Infect Dis 17:461–3

    PubMed  CAS  Google Scholar 

  26. Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R et al (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18:3038–51

    PubMed  CAS  Google Scholar 

  27. Klastersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L et al (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24:4129–34

    Article  PubMed  CAS  Google Scholar 

  28. Talcott JA, Siegel RD, Finberg R, Goldman L (1992) Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol 10:316–22

    PubMed  CAS  Google Scholar 

  29. Talcott JA, Siegal RD, Finberg R, Goldman L (1988) The medical course of cancer patients with fever and neutropenia: clinical identification of a low-risk subgroup at presentation. Arch Intern Med 108:2561

    Article  Google Scholar 

  30. Cordonnier C, Herbrecht R, Pico JL, Gardembas M et al (1997) Cefepime/amikacin versus ceftazidime/amikacin as empirical therapy for febrile episodes in neutropenic patients: a comparative study. Clin Infect Dis 24:41–51

    Article  PubMed  CAS  Google Scholar 

  31. Peacock JE, Herrington DA, Wade JC, Lazarus HM et al (2002) Ciprofloxacin plus piperacillin compared with tobramycin plus piperacillin as empirical therapy in febrile neutropenic patients. Ann Intern Med 137:77–86

    PubMed  CAS  Google Scholar 

  32. Sanz MA, Lopez J, Lahuerta JJ, Rovira M et al (2002) Cefepime plus amikacin versus piperacillin-tazobactam plus amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia: results of an open, randomized, multicentre trial. J Antimicrob Chemother 50:79–88

    Article  PubMed  CAS  Google Scholar 

  33. Pizzo PA, Hathorn JW, Hiemenz J, Browne M et al (1986) A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315:552–558

    Article  PubMed  CAS  Google Scholar 

  34. Cometta A, Zinner S, de Bock R, Calandra T et al (1995) Piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 39: 445–452

    PubMed  CAS  Google Scholar 

  35. Phillips B, Selwood K, Lane SM, Skinner R et al (2007) Variation in policies for the management of febrile neutropenia in United Kingdom Children’s Cancer Study Group centres. Arch Dis Child 92:495–498

    Article  PubMed  Google Scholar 

  36. Haynes AB, Weiser TG, Berry WR, Lipsitz SR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499

    Article  PubMed  CAS  Google Scholar 

  37. Provonost P, Needham D, Berenholz S, Sinopoli D et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 355:2725–2732

    Article  Google Scholar 

  38. Akova M, Paesmans M, Calandra T, Viscoli C (2005) A European Organization for Research and Treatment of Cancer-international antimicrobial therapy group study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 40:239–245

    Article  PubMed  Google Scholar 

  39. Nucci M, Spector N, Bueno AP, Solza C et al (1997) Risk factors and attributable mortality associated with superinfection in neutropenic patients with cancer. Clin Infect Dis 24:575–579

    Article  PubMed  CAS  Google Scholar 

  40. Brown AE (1984) Neutropenia, fever, and infection. Am J Med 76:421–426

    Article  PubMed  CAS  Google Scholar 

  41. Elting LS, Rubenstein EB, Rolston KVI, Bodey GP (1997) Outcomes of bacteremia in patients with cancer and neutropenia: observations from two decades of epidemiological and clinical trials. Clin Infect Dis 25:247–259

    Article  PubMed  CAS  Google Scholar 

  42. Copelan E, Casper JT, Carter SL, van Burik JH et al (2007) A scheme for defining cause of death and its application in the T cell depletion trial. Biol Blood Marrow Trans 13:1469–1476

    Article  Google Scholar 

  43. Bennett JE, Powers J, Walsh T, Viscoli C et al (2003) Forum report: issues in clinical trials of empirical antifungal therapy in treating febrile neutropenic patients. Clin Infect Dis 36(Suppl 3):S117–122

    Article  PubMed  Google Scholar 

  44. Herbrecht R, Denning DW, Patterson TF, Bennett JE et al (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Infectious Diseases, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Michael Kleinberg M.D., Ph.D.

  2. Health Sciences Centre, Winnipeg, MB, Canada

    E. J. Bow M.D.

Authors
  1. Michael Kleinberg M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. J. Bow M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Kleinberg M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. School of Medicine, University of Maryland, S. Greene St. 22, Baltimore, 21201, U.S.A.

    Michael Kleinberg

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Humana Press

About this chapter

Cite this chapter

Kleinberg, M., Bow, E.J. (2009). Introduction: Approach to the Patient. In: Kleinberg, M. (eds) Managing Infections in Patients With Hematological Malignancies. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-415-5_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-415-5_1

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-986-4

  • Online ISBN: 978-1-59745-415-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation