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Las infecciones son la principal causa de muerte en los pacientes neutropénicos, en relación con el grado y la duración de la neutropenia, la enfermedad de base y los tratamientos recibidos. Para disminuir estas infecciones se han propuesto estrategias de profilaxis: medidas para evitar el contagio por contacto, por inhalación o por vía digestiva. Aunque la descontaminación intestinal con fluoroquinolonas ha reducido las infecciones por bacilos gramnegativos, no se recomienda su uso indiscriminado, sino reservar su utilización para pacientes de muy alto riesgo. El fluconazol como profilaxis antifúngica reduce la mortalidad, pero no modifica la incidencia de la aspergilosis invasiva. La infección por citomegalovirus debe prevenirse en los pacientes con serología negativa; en los que presentan una serología positiva con alto riesgo de enfermedad se recomienda la monitorización y el tratamiento anticipado con ganciclovir o foscarnet. Los factores de crecimiento hematopoyético reducen la duración de la neutropenia y podrían reducir la mortalidad de causa infecciosa.
Palabras clave:
Neutropenia
Infección bacteriana
Infección fúngica
Infección viral
Profilaxis
Infections are the main cause of death in neutropenic patients and are related to the degree and duration of neutropenia, the underlying disease, and the treatments received. To reduce the number of these infections, prophylactic strategies have been proposed. These strategies aim to prevent adquisition through contact, inhalation, or the gastrointestinal tract. Intestinal decontamination through fluoroquinolones has reduced Gram-negative infections but this strategy should not be used indiscriminately and should be reserved for high risk patients. Fluconazole as antifungal prophylaxis reduces mortality but does not modify the incidence of invasive aspergillosis. Cytomegalovirus infection should be prevented in patients with negative serology; in high risk patients with positive serology, monitoring and preemptive treatment with ganciclovir or foscarnet is recommended. Hematopoietic growth factors reduce the duration of neutropenia and could reduce mortality from infection.
Key words:
Neutropenia
Bacterial infection
Fungal infection
Viral infection
Prophylaxis
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