Skip to main content

Advertisement

Log in

Diagnosis and treatment of documented infections in neutropenic patients

Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Approximately 85% of patients with acute leukemia undergoing intensive antileukemic treatment develop infections and/or fever during neutropenic phases; in about 50% of these patients clinical, microbiological or clinical and microbiological evidence of infections can be obtained. The response rate is significantly lower in documented infections than in fever of unknown origin (FUO). Evidence-based recommendations for diagnosis and treatment procedures are presented, reflecting study results and expert opinions.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen U, Smith CR, Prober CG (1986) The value of skin biopsies in febrile, neutropenic, immunocompromised children. Am J Dis Child 140:459–461

    CAS  PubMed  Google Scholar 

  2. Bochud PY, Calandra T, Francioli P (1994) Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med 97:256–264

    CAS  PubMed  Google Scholar 

  3. Buchheidt D, Böhme A, Cornely O, Fätkenheuer G, Fuhr HG, Heussel G, Junghanss C, Karthaus M, Kellner O, Kern W, Schiel X, Sezer O, Südhoff T, Szelenyi H (2001) Dokumentierte Infektionen bei Neutropenie—Empfehlungen zu Diagnostik und Therapie. Dtsch Med Wochenschr 126:1085–1090

    Article  CAS  PubMed  Google Scholar 

  4. Chirletti P, Barillari P, Sammartino P, Cardi M, Caronna R, Arcese W, Petti C, Stipa V (1993) The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 9:237–241

    CAS  PubMed  Google Scholar 

  5. Cornely OA, Schirmacher P (2001) Clinical picture: Bacterial translocation in neutropenic sepsis. Lancet 358:1842

    Article  CAS  PubMed  Google Scholar 

  6. Denning DW, Evans EG, Kibbler CC, Richardson MD, Roberts MM, Rogers TR, Warnock DW, Warren RE (1997) Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. British Society for Medical Mycology. Eur J Clin Microbiol Infect Dis 16:424–436

    CAS  PubMed  Google Scholar 

  7. Elting LS, Rubenstein EB, Rolston KV, 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

    CAS  PubMed  Google Scholar 

  8. Escande MC, Herbrecht R (1998) Prospective study of bacteraemia in cancer patients. Results of a French multicentre study. Support Care Cancer 6:273–280

    Article  CAS  PubMed  Google Scholar 

  9. Fätkenheuer G, Buchheidt D, Cornely OA, Fuhr HG, Karthaus M, Kisro J, Leithäuser M, Salwender H, Südhoff T, Szelényi H (2003) Central venous catheter (CVC)-related infections in neutropenic patients. Ann Hematol 82 (Suppl 2) DOI 10.1007/s00277-003-0769-z

    Google Scholar 

  10. French G (2003) Safety and tolerability of linezolid. J Antimicrob Chemother 51 (Suppl 2):II45-II53

    Google Scholar 

  11. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr (1995) Society for Healthcare and Epidemiology of America: Position Paper on Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 459–477

    Google Scholar 

  12. Gorschlüter M, Glasmacher A, Hahn C, Leutner C, Marklein G, Remig J, Schmidt-Wolf IG, Sauerbruch T (2001) Severe abdominal infections in neutropenic patients. Cancer Invest 19:669–677

    Article  CAS  PubMed  Google Scholar 

  13. Gorschlüter M, Glasmacher A, Hahn C, Schakowski F, Ziske C, Molitor E, Marklein G, Sauerbruch T, Schmidt-Wolf IG (2001) Clostridium difficile infection in patients with neutropenia. Clin Infect Dis 33:786–791

    Article  PubMed  Google Scholar 

  14. Gorschlüter M, Marklein G, Hofling K, Clarenbach R, Baumgartner S, Hahn C, Ziske C, Mey U, Heller R, Eis-Hubinger AM, Sauerbruch T, Schmidt-Wolf IG, Glasmacher A (2002) Abdominal infections in patients with acute leukaemia: a prospective study applying ultrasonography and microbiology. Br J Haematol 117:351–358

    Article  PubMed  Google Scholar 

  15. Hiddemann W, Maschmeyer G, Link H, Helmerking M, Adam D (1997) Therapy of infections in patients with acute leukemia. Med Klin 92:406–409

    CAS  PubMed  Google Scholar 

  16. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  17. Hughes WT, Armstrong D, Bodey GP, Brown AE, Edwards JE, Feld R, Pizzo P, Rolston KV, Shenep JL, Young LS (1997) 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America. Clin Infect Dis 25:551–573

    CAS  PubMed  Google Scholar 

  18. Kern WV, Beyer J, Böhme A, Buchheidt D, Cornely O, Einsele H, Kisro J, Krüger W, Maschmeyer G, Ruhnke M, Schmidt CA, Schwartz S, Szelenyi H (2000) Prophylaxis of infection in neutropenic patients. Guidelines of the Working Party on Infections in Hematology and Oncology. Dtsch Med Wochenschr 125:1582–1588

    Article  CAS  PubMed  Google Scholar 

  19. Kish MA (2001) Guide to development of practice guidelines. Clin Infect Dis 32:851–854

    Article  CAS  PubMed  Google Scholar 

  20. Link H, Böhme A, Cornely OA, Höffken K, Kellner O, Kern WV, Mahlberg R, Maschmeyer G, Nowrousian MR, Ostermann H, Ruhnke M, Sezer O, Schiel X, Wilhelm M, Auner HW (2003) Antimicrobial therapy of unexplained fever in neutropenic patients. Ann Hematol 82 (Suppl 2) DOI 10.1007/s00277-003-0764-4

    Google Scholar 

  21. Link H, Maschmeyer G, Meyer P, Hiddemann W, Stille W, Helmerking M, Adam D (1994) Interventional antimicrobial therapy in febrile neutropenic patients. Study Group of the Paul Ehrlich Society for Chemotherapy. Ann Hematol 69:231–243

    CAS  PubMed  Google Scholar 

  22. Maschmeyer G (1999) Interventional antimicrobial therapy in febrile neutropenic patients. Diagn Microbiol Infect Dis 34:205–212

    Article  CAS  PubMed  Google Scholar 

  23. Maschmeyer G, Beinert T, Buchheidt D, Einsele H, Heussel CP, Kiehl M, Lorenz J (2003) Diagnosis and antimicrobial therapy of pulmonary infiltrates in febrile neutropenic patients. Ann Hematol 82 (Suppl 2) DOI 10.1007/s00277-003-0765-3

    Google Scholar 

  24. Maschmeyer G, Hiddemann W, Link H, Cornely OA, Buchheidt D, Glass B, Adam D (1997) Management of infections during intensive treatment of hematologic malignancies. Ann Hematol 75:9-16

    Article  CAS  PubMed  Google Scholar 

  25. Maschmeyer G, Link H, Hiddemann W, Meyer P, Helmerking M, Eisenmann E, Schmitt J, Adam D (1994) Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer 73:2296–2304

    CAS  PubMed  Google Scholar 

  26. McFarland LV, Mulligan ME, Kwok RY, Stamm WE (1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320:204–210

    CAS  PubMed  Google Scholar 

  27. Montalban C, Patier JL, Calleja JL, Perales J, Serrano M, Bellas C (1989) Neutropenic enterocolitis during treatment of lymphoproliferative neoplasms. Med Clin (Barc) 93:649–652

    Google Scholar 

  28. Pizzo PA, Ladisch S, Ribichaud K (1980) Treatment of Gram-positive septicemia in cancer patients. Cancer 45:206–207

    CAS  PubMed  Google Scholar 

  29. Raad I, Narro J, Khan A, Tarrand J, Vartivarian S, Bodey GP (1992) Serious complications of vascular catheter-related Staphylococcus aureus bacteremia in cancer patients. Eur J Clin Microbiol Infect Dis 11:675–682

    CAS  PubMed  Google Scholar 

  30. Seifert H, Cornely O, Seggewiss K, Decker M, Stefanik D, Wisplinghoff H, Fätkenheuer G (2003) Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis. J Clin Microbiol 41:118–123

    Article  PubMed  Google Scholar 

  31. Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH (1986) The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer 57:603–609

    CAS  PubMed  Google Scholar 

  32. Shim JK, Johnson S, Samore MH, Bliss DZ, Gerding DN (1998) Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet 351:633–636

    Article  CAS  PubMed  Google Scholar 

  33. Smith PF, Birmingham MC, Noskin GA, Meagher AK, Forrest A, Rayner CR, Schentag JJ (2003) Safety, efficacy and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia. Ann Oncol 14:795–801

    Article  CAS  PubMed  Google Scholar 

  34. Teasley DG, Gerding DN, Olson MM, Peterson LR, Gebhard RL, Schwartz MJ, Lee JTJ (1983) Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet 2:1043–1046

    CAS  PubMed  Google Scholar 

  35. Wade DS, Nava HR, Douglass HOJ (1992) Neutropenic enterocolitis. Clinical diagnosis and treatment. Cancer 69:17–23

    CAS  PubMed  Google Scholar 

  36. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB (2003) 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 36:1103–1110

    Article  PubMed  Google Scholar 

  37. Yuen KY, Woo PC, Liang RH, Chiu EK, Chen FF, Wong SS, Lau YL, Ha SY, Peiris JS, Siau H, Chan TK (1998) Clinical significance of alimentary tract microbes in bone marrow transplant recipients. Diagn Microbiol Infect Dis 30:75–81

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dieter Buchheidt.

Additional information

This paper is not concerned with standard recommendations and guidelines for the diagnosis and treatment of fever of unknown origin, fungal infections, infections after hematological stem cell transplantation, sepsis in neutropenia, venous catheter-associated infections, lung infiltrates in neutropenic patients or infection prophylaxis. All these are subject to separate guideline papers of the Infectious Diseases Working Party of the German Society of Hematology and Oncology (DGHO), published in this issue of Annals of Hematology.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buchheidt, D., Böhme, A., Cornely, O.A. et al. Diagnosis and treatment of documented infections in neutropenic patients. Ann Hematol 82 (Suppl 2), S127–S132 (2003). https://doi.org/10.1007/s00277-003-0766-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-003-0766-2

Keywords

Navigation