Abstract
Severe infections in neutropenic patient often progress rapidly leading to life-threatening organ dysfunction requiring admission to the Intensive Care Unit. Management strategies include early adequate appropriate empirical antimicrobial, early admission to ICU to avoid any delay in the diagnostic and therapeutic management of organ dysfunction. This review discusses the main clinical situations encountered in critically ill neutropenic patients. Specific diagnostic and therapeutic approaches have been proposed for acute respiratory failure, shock, neutropenic enterocolitis, catheter-related infections, cellulitis and primary bacteriemia. Non anti-infectious agents and recent advances will also be discussed. At present, most of large-scale studies and recommendations in neutropenic patients stem from hematological patients and will need further validation in ICU patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-512) contains supplementary material, which is available to authorized users.
Highlights
Neutropenia is a decrease in circulating neutrophil counts in the peripheral blood
Empirical antimicrobial therapy in Intensive Care Unit (ICU) In severe infections, empirical antibiotic/antifungal therapy in suspected infections should be tailored to the individual patient to maximize the chances that the therapy is microbiologically appropriate
We described previously the most important criteria to consider when evaluating these patients, using the mnemonic DIRECT [31,33]: Delay since the onset of malignancy or haematopoietic stemcell transplantation (HSCT), since symptom onset and since the implementation of antibiotics/prophylaxis; pattern of Immune deficiency; Radiographic appearance; Experience and knowledge of the literature; Clinical picture; and findings by high-resolution computed Tomography (CT) of the chest [31,33]
Summary
Neutropenia is a decrease in circulating neutrophil counts in the peripheral blood. An absolute neutrophil count of 1,000– 1,500 cells/mm defines mild neutropenia, 500–1,000 cells/mm defines moderate neutropenia, and
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
