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Inicio Enfermedades Infecciosas y Microbiología Clínica Neutropenia febril: pasado, presente y futuro
Información de la revista
Vol. 23. Núm. S5.
Infecciones en pacientes neutropénicos
Páginas 2-6 (diciembre 2005)
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Vol. 23. Núm. S5.
Infecciones en pacientes neutropénicos
Páginas 2-6 (diciembre 2005)
Infecciones en pacientes neutropénicos
Acceso a texto completo
Neutropenia febril: pasado, presente y futuro
Febrile neutropenia: past, present and future
Visitas
7324
Enric Carreras
, Josep Mensa
Servicio de Hematología y Enfermedades Infecciosas. Hospital Clínic Universitari. IDIBAPS. Barcelona. España
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La presente revisión pretende ofrecer una visión de conjunto de los cambios que se han ido produciendo durante los últimos 40 años en los agentes etiológicos aislados en los pacientes neutropénicos con fiebre, así como en sus patrones de sensibilidad a los antibacterianos y su implicación en las pautas de tratamiento empírico. Esta visión global permite observar cómo los cambios introducidos en el tratamiento de estos pacientes se han acompañado, de forma indefectible, de cambios en los microorganismos causales, que a su vez han obligando a rediseñar las pautas terapéuticas. Estos constantes cambios, así como los notables avances alcanzados en las técnicas diagnósticas y en el reconocimiento de subpoblaciones de pacientes con distintos grados de morbimortalidad, obligan a los diversos especialistas implicados en el manejo de los pacientes neutropénicos con fiebre a una constate actualización de sus conocimientos.

Palabras clave:
Neutropenia febril
Cáncer
Infección
Paciente inmunodeprimido

The present review aims to provide an overall view of the changes that have occurred in the last 40 years in the etiological agents isolated in febrile neutropenic patients, as well as in their antibacterial susceptibility patterns and their involvement in empirical treatment regimes. This overall view allows us to observe how the modifications introduced in the treatment of these patients has been accompanied by continual changes in the causative microorganisms, which in turn has required treatment regimens to be redesigned. Because of these constant changes, the significant advances achieved in diagnostic techniques and the recognition of subpopulations of patients with distinct degrees of morbidity and mortality, specialists in the various fields involved in the management of febrile neutropenic patients must constantly update their knowledge.

Key words:
Febrile neutropenia
Cancer
Infection
Immunodepressed patient
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Bibliografía
[1.]
G.P. Bodey, M. Buckley, Y.S. Sathe, E.J. Freireich.
Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia.
Ann Intern Med, 64 (1966), pp. 328-340
[2.]
S.L. Gerson, G.H. Talbot, S. Hurwitz, B.L. Strom, E.J. Lusk, P.A. Cassileth.
Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia.
Ann Intern Med, 100 (1984), pp. 345-351
[3.]
E.A. Sickles, W.H. Greene, P.H. Wiernik.
Clinical presentation of infection in granulocytopenic patients.
Arch Intern Med, 135 (1975), pp. 715-719
[4.]
N.V. Sipsas, G.P. Bodey, D.P. Kontoyiannis.
Perspectives for the management of febrile neutropenic patients with cancer in the 21st century.
Cancer, 103 (2005), pp. 1103-1113
[5.]
E.J. Bow.
Management of the febrile neutropenic cancer patient: lessons from 40 years of study.
Clin Microbiol Infect, 11 (2005), pp. 24-29
[6.]
K.V.I. Rolston, I. Raad, E. Whimbey, G.P. Bodey.
The changing spectrum of bacterial infections in febrile neutropenic patients.
Febrile neutropenia, pp. 53-56
[7.]
S.C. Schimpff.
Fever and neutropenia: and historical perspective.
Texbook of febrile neutropenia,
[8.]
C. Viscoli, por el EORTC International Antimicrobial Therapy Group Management of infection in cancer patients. studies of the EORTC International Antimicrobial Therapy Group (IATG).
Eur J Cancer, 38 (2002), pp. 82-87
[9.]
M.A. Sanz, A. Bermúdez, M. Rovira, J. Besalduch, M.J. Pascual, G. Nocea, for the COSTINE Study Group, et al.
Imipenem/cilastatin versus piperacillin/tazobactam plus amikacin for empirical therapy in febrile neutropenic patients: results of the COSTINE study.
Curr Med Res Opin, 21 (2005), pp. 645-655
[10.]
M. Ribas-Mundó, A. Grañena, C. Rozman.
Evaluation of a protective environment in the management of granulocytopenic patients: a comparative study.
Cancer, 48 (1981), pp. 419-424
[11.]
B. Hayes-Lattin, J.F. Leis, R.T. Maziarz.
Isolation in the allogeneic transplant environment: how protective is it?.
Bone Marrow Transplant, 36 (2005), pp. 373-381
[12.]
W.H. Krüger, R.J. Hornung, R. Hertenstein, et al.
Practices of infectious diseases prevention and management during haematopoietic stem cell transplantation: a survey from the European group for blood and marrow transplantation.
J Hematother Stem Cell Res, 10 (2001), pp. 895-903
[13.]
W.T. Hughes.
Trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonitis in children.
Rev Infect Dis, 4 (1982), pp. 602-607
[14.]
D. Van der Waaij.
Colonization resistance of the digestive tract: clinical consequences and implications.
J Antimicrob Chemother, 10 (1982), pp. 263-270
[15.]
E.A. Engels, J. Lau, M. Barza.
Efficacy of quinolone prophylaxis in neutropenic cancer patients: a meta-analysis.
J Clin Oncol, 16 (1998), pp. 1179-1187
[16.]
P.A. Pizzo, K.J. Robichaud, F.A. Gill, F.G. Witebsky.
Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia.
Am J Med, 72 (1982), pp. 101-111
[17.]
S.C. Schimpff, V.M. Young, W.H. Greene, G.D. Vermeulen, M.R. Moody, P.H. Wiernik.
Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens.
Ann Intern Med, 77 (1972), pp. 707-714
[18.]
Empiric antifungal therapy in febrile granulocytopenic patients. EORTC International Antimicrobial Therapy Cooperative Group. Am J Med. 1989; 86:668-72.
[19.]
C. Rozman, M. Ribas-Mundó, A. Grañena, R. Castillo.
Granulocyte transfusion. Experiences with 92 cases.
Nouv Rev Fr Hematol, 16 (1976), pp. 154-159
[20.]
H. Ozer, J.O. Armitage, C.L. Bennett, J. Crawford, G.D. Demetri, P.A. Pizzo, por la American Society of Clinical Oncology, et al.
2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidencebased, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel.
J Clin Oncol, 18 (2000), pp. 3558-3585
[21.]
P.A. Pizzo, K.J. Robichaud, F.A. Gill, F.G. Witebsky, A.S. Levine, A.B. Deisseroth, et al.
Duration of empiric antibiotic therapy in granulocytopenic patients with cancer.
Am J Med, 67 (1979), pp. 194-200
[22.]
J.A. García-Rodríguez, M. Gobernado, M. Gomis, J. Mensa, J. Picazo, J. Prieto, por la Sociedad Española de Quimioterapia; Asociación Española de Hematología y Hemoterapia, et al.
Clinical guide for the evaluation and treatment of patients with neutropenia and fever.
Rev Esp Quimioter, 14 (2001), pp. 75-83
[23.]
M. Ortega, M. Rovira, M. Almela, F. Marco, J.P. De la Bellacasa, J.A. Martínez, et al.
Bacterial and fungal bloostream isolates from 796 hematopoietic stem cell transplant recipients between 1991 and 2000.
Ann Hematol, 84 (2005), pp. 40-46
[24.]
D. Yadegarynia, J. Tarrand, I. Raad, K. Rolston.
Current spectrum of bacterial infections in patients with cancer.
Clin Infect Dis, 37 (2003), pp. 1144-1145
[25.]
M.S. Wilke, A.L. Lovering, N.C. Strynadka.
Beta-lactam antibiotic resistance: a current structural perspective.
Curr Opin Microbiol, 8 (2005), pp. 525-533
[26.]
H. Wisplinghoff, H. Seifert, R.P. Wenzel, M.B. Edmond.
Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States.
Clin Infect Dis, 36 (2003), pp. 1103-1110
[27.]
A.K. Zaas, X. Song, P. Tucker, T.M. Perl.
Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci.
Clin Infect Dis, 35 (2002), pp. 1139-1146
[28.]
K.A. Marr, R.A. Carter, M. Boeckh, P. Martin, L. Corey.
Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors.
Blood, 100 (2002), pp. 4358-4366
[29.]
D.M. Livermore.
Minimising antibiotic resistance.
Lancet Infect Dis, 5 (2005), pp. 450-459
[30.]
M. Cruciani, M. Malena, O. Bosco, S. Nardi, G. Serpelloni, C. Mengoli.
Reappraisal with meta-analysis of the addition of Gram-positive prophylaxis to fluoroquinolone in neutropenic patients.
J Clin Oncol, 21 (2003), pp. 4127-4137
[31.]
M. Paul, K. Soares-Weiser, L. Leibovici.
Beta-lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis.
BMJ, 326 (2003), pp. 1111-1120
[32.]
P. Furno, G. Bucaneve, A. Del Favero.
Monotherapy or aminoglycoside-containing combinations for empirical antibiotic treatment of febrile neutropenic patients: a meta-analysis.
Lancet Infect Dis, 2 (2002), pp. 231-242
[33.]
Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)? Link H, Bohme A, Cornely OA, Hoffken K, Kellner O, Kern WV, et al. 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 Ann Hematol. 2003;82 Suppl 2:105-17.
[34.]
W.T. Hughes, D. Armstrong, G.P. Bodey, E.J. Bow, A.E. Brown, T. Calandra, et al.
2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.
Clin Infect Dis, 34 (2002), pp. 730-751
[35.]
R. Feld.
Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer: pros and cons.
Clin Infect Dis, 29 (1999), pp. 503-507
[36.]
J. Klastersky.
Antifungal therapy in patients with fever and neutropenia—more rational and less empirical?.
N Engl J Med, 351 (2004), pp. 1445-1447
[37.]
M. Rovira, M. Jiménez, J.P. De la Bellacasa, J. Mensa, M. Rafel, M. Ortega, et al.
Detection of Aspergillus galactomannan by enzyme immunoabsorbent assay in recipients of allogeneic hematopoietic stem cell transplantation: a prospective study.
Transplantation, 77 (2004), pp. 1260-1264
[38.]
J. Maertens, K. Theunissen, E. Verbeken, K. Lagrou, J. Verhaegen, M. Boogaerts, et al.
Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients.
Br J Haematol, 126 (2004), pp. 852-860
[39.]
D. Caillot, J.F. Couaillier, A. Bernard, O. Casasnovas, D.W. Denning, L. Mannone, et al.
Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia.
J Clin Oncol, 19 (2001), pp. 253-259
[40.]
F. Marco, C. Danes, M. Almela, A. Jurado, J. Mensa, J.P. De la Bellacasa, et al.
Trends in frequency and in vitro susceptibilities to antifungal agents, including voriconazole and anidulafungin, of Candida bloodstream isolates. Results from a six-year study (1996-2001).
Diagn Microbiol Infect Dis, 46 (2003), pp. 259-264
[41.]
S.P. Robinson, D.I. Marks.
Granulocyte transfusions in the G-CSF era. Where do we stand?.
Bone Marrow Transplant, 34 (2004), pp. 839-846
[42.]
J.A. Talcott, R.D. Siegel, R. Finberg, L. Goldman.
Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule.
J Clin Oncol, 10 (1992), pp. 316-322
[43.]
J. Klastersky, M. Paesmans, E.B. Rubenstein, M. Boyer, L. Elting, R. Feld, et al.
The Multinational Association for Supportive Care in Cancer risk index: Amultinational scoring system for identifying low-risk febrile neutropenic cancer patients.
J Clin Oncol, 18 (2000), pp. 3038-3051
[44.]
B.M. Svahn, O. Ringden, M. Remberger.
Long-term follow-up of patients treated at home during the pancytopenic phase after allogeneic haematopoietic stem cell transplantation.
Bone Marrow Transplant, 36 (2005), pp. 511-516
[45.]
M. Ortega, M. Rovira, M. Almela, J.P. De la Bellacasa, E. Carreras, J. Mensa.
Measurement of C-reactive protein in adults with febrile neutropenia after hematopoietic cell transplantation.
Bone Marrow Transplant, 33 (2004), pp. 741-744
[46.]
M. Ortega, M. Rovira, X. Filella, M. Almela, J. Puig de la Bellacasa, E. Carreras, J. Mensa.
Prospective evaluation of procalcitonin in adults with febrile neutropenia after haematopoietic stem cell transplantation.
Br J Haematol, 126 (2004), pp. 372-376
[47.]
A. Nosari, M. Anghilieri, G. Carrafiello, C. Guffanti, L. Marbello, M. Montillo, et al.
Utility of percutaneous lung biopsy for diagnosing filamentous fungal infections in hematologic malignancies.
Haematologica, 88 (2003), pp. 1405-1409
[48.]
G. Bucaneve, A. Micozzi, F. Menichetti, P. Martino, M.S. Dionisi, G. Martinelli, et al.
Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia.
N Engl J Med, 353 (2005), pp. 977-987
[49.]
M. Cullen, N. Steven, L. Billingham, C. Gaunt, M. Hastings, P. Simmonds, et al.
Chemotherapy +/− Antibiotic in a Number of Tumours (SIGNIFICANT) Trial Group. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas.
N Engl J Med, 353 (2005), pp. 988-998
[50.]
A. Gafter-Gvili, A. Fraser, M. Paul, L. Leibovici.
Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients.
Ann Intern Med, 142 (2005), pp. 979-995
[51.]
O.W. Neth, M. Bajaj-Elliott, M.W. Turner, N.J. Klein.
Susceptibility to infection in patients with neutropenia: the role of the innate immune system.
Br J Haematol, 129 (2005), pp. 713-722
[52.]
T. Horiuchi, H. Gondo, H. Miyagawa, J. Otsuka, S. Inaba, K. Nagafuji, et al.
Association of MBL gene polymorphisms with major bacterial infection in patients treated with high-dose chemotherapy and autologous PBSCT.
Genes Immun, 6 (2005), pp. 162-166
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