European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia.

Détails

Ressource 1Télécharger: BIB_3D5AD3939EF5.P001.pdf (1323.12 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_3D5AD3939EF5
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia.
Périodique
Haematologica
Auteur(s)
Averbuch D., Orasch C., Cordonnier C., Livermore D.M., Mikulska M., Viscoli C., Gyssens I.C., Kern W.V., Klyasova G., Marchetti O., Engelhard D., Akova M., ECIL4 a joint venture of EBMT EORTC ICHS ESGICH/ESCMID , ELN 
Contributeur(s)
ECIL4 a joint venture of EBMT EORTC ICHS ESGICH/ESCMID , ELN 
ISSN
1592-8721 (Electronic)
ISSN-L
0390-6078
Statut éditorial
Publié
Date de publication
2013
Volume
98
Numéro
12
Pages
1826-1835
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish. pdf type: guideline article
Résumé
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'de-escalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance.
Pubmed
Web of science
Open Access
Oui
Création de la notice
14/01/2014 17:21
Dernière modification de la notice
20/08/2019 14:33
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