Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- 83 Evaluation of Suspected Immunodeficiency
- 84 Infections in the Neutropenic Patient
- 85 Infections in Patients with Neoplastic Disease
- 86 Corticosteroids, Cytotoxic Agents, and Infection
- 87 Infections in Transplant Patients
- 88 Diabetes and Infection
- 89 Infectious Complications in the Injection Drug User
- 90 Infections in the Alcoholic
- 91 Infections in the Elderly
- 92 Neonatal Infection
- 93 Pregnancy and the Puerperium: Infectious Risks
- 94 Dialysis-Related Infection
- 95 Overwhelming Postsplenectomy Infection
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
84 - Infections in the Neutropenic Patient
from Part XI - The Susceptible Host
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- 83 Evaluation of Suspected Immunodeficiency
- 84 Infections in the Neutropenic Patient
- 85 Infections in Patients with Neoplastic Disease
- 86 Corticosteroids, Cytotoxic Agents, and Infection
- 87 Infections in Transplant Patients
- 88 Diabetes and Infection
- 89 Infectious Complications in the Injection Drug User
- 90 Infections in the Alcoholic
- 91 Infections in the Elderly
- 92 Neonatal Infection
- 93 Pregnancy and the Puerperium: Infectious Risks
- 94 Dialysis-Related Infection
- 95 Overwhelming Postsplenectomy Infection
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
Patients receiving cancer chemotherapy are at high risk for developing neutropenia and severe infections when their neutrophil count is depressed. There is no strict definition of neutropenia, but this term is used to define an absolute neutrophil count ≤1500 cells down to an absolute neutrophil count ≤500 cells/mL. Fever in the neutropenic patient is defined as a single temperature of >38.3°C or a temperature of >38.0°C over at least 30 minutes to 1 hour. However, some neutropenic patients do not mount a fever, and the presence of hypotension and hypothermia may be the presenting feature of infection.
Over the years, different approaches have been developed to address the clinical entity of fever and neutropenia. Some research has looked at preventing neutropenia with the use of colony-stimulating factors. Other research has focused on preventing infection in the neutropenic patient; still others have looked at the empiric use of antimicrobials to treat infections when fever occurs. In this chapter, I focus on these three approaches as well as the main causes of infections in these severely immunocompromised individuals.
CAUSES OF INFECTION IN THE NEUTROPENIC PATIENT
Gram-Negative Organisms
Enteric gram-negative organisms play a significant role in the morbidity and mortality due to infection in our neutropenic patients. These include Escherichia coli, Klebsiella spp., and Enterobacter spp. among others. These organisms can gain entry into the bloodstream and lead to serious infections as a result of mucosal damage and the ability of the organism to disseminate.
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- Clinical Infectious Disease , pp. 593 - 600Publisher: Cambridge University PressPrint publication year: 2008