Universität zu Köln

Heinz, W. J., Buchheidt, D., Christopeit, M., von Lilienfeld-Toal, M., Cornely, O. A., Einsele, H., Karthaus, M., Link, H., Mahlberg, R., Neumann, S., Ostermann, H., Penack, O., Ruhnke, M., Sandherr, M., Schiel, X., Vehreschild, J. J., Weissinger, F. and Maschmeyer, G. (2017). Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann. Hematol., 96 (11). S. 1775 - 1793. NEW YORK: SPRINGER. ISSN 1432-0584

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Abstract

Fever may be the only clinical symptom at the onset of infection in neutropenic cancer patients undergoing myelosuppressive chemotherapy. A prompt and evidence-based diagnostic and therapeutic approach is mandatory. A systematic search of current literature was conducted, including only full papers and excluding allogeneic hematopoietic stem cell transplant recipients. Recommendations for diagnosis and therapy were developed by an expert panel and approved after plenary discussion by the AGIHO. Randomized clinical trials were mainly available for therapeutic decisions, and new diagnostic procedures have been introduced into clinical practice in the past decade. Stratification into a high-risk versus low-risk patient population is recommended. In high-risk patients, initial empirical antimicrobial therapy should be active against pathogens most commonly involved in microbiologically documented and most threatening infections, including Pseudomonas aeruginosa, but excluding coagulase-negative staphylococci. In patients whose expected duration of neutropenia is more than 7 days and who do not respond to first-line antibacterial treatment, specifically in the absence of mold-active antifungal prophylaxis, further therapy should be directed also against fungi, in particular Aspergillus species. With regard to antimicrobial stewardship, treatment duration after defervescence in persistently neutropenic patients must be critically reconsidered and the choice of anti-infective agents adjusted to local epidemiology. This guideline updates recommendations for diagnosis and empirical therapy of fever of unknown origin in adult neutropenic cancer patients in light of the challenges of antimicrobial stewardship.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heinz, W. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchheidt, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Christopeit, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED von Lilienfeld-Toal, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Einsele, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Karthaus, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Link, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mahlberg, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ostermann, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Penack, O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhnke, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sandherr, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiel, X. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, J. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Weissinger, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Maschmeyer, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-213231
DOI:	10.1007/s00277-017-3098-3
Journal or Publication Title:	Ann. Hematol.
Volume:	96
Number:	11
Page Range:	S. 1775 - 1793
Date:	2017
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-0584
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE FUNGAL-INFECTIONS; BLOOD-STREAM INFECTION; C-REACTIVE PROTEIN; LIPOSOMAL AMPHOTERICIN-B; VANCOMYCIN-RESISTANT ENTEROCOCCI; PREEMPTIVE ANTIFUNGAL THERAPY; DETERIORATING CLINICAL-COURSE; CELL TRANSPLANT RECIPIENTS; EARLY HOSPITAL DISCHARGE; 4TH EUROPEAN CONFERENCE Multiple languages Hematology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21323