J R de la Court1,2, A H W Bruns3, A H E Roukens4, I O Baas5, K van Steeg6, M L Toren-Wielema7, M Tersmette8, N M A Blijlevens9, R A G Huis In 't Veld10, T F W Wolfs11, W J E Tissing12,13, Y Kyuchukova10, J Heijmans14. 1. Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Infectious Diseases, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands. 4. Department of Infectious Diseases, Leiden University Centre of Infectious Diseases, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands. 5. Department of Medical Oncology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands. 6. Department of Clinical Pharmacology, ZGT Hospital, University of Groningen, Almelo and Hengelo, The Netherlands. 7. Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 8. Department of Medical Microbiology and Immunology, Sint Antonius Hospital, Nieuwegein and Utrecht, The Netherlands. 9. Department of Haematology, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands. 10. Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 11. Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands. 12. Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 13. Department of Pediatric Oncology and Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. 14. Department of Haematology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. j.heijmans@amsterdamumc.nl.
Abstract
INTRODUCTION: This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and pediatric patients. METHOD: The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010-2020) and, where necessary, supplemented by expert-based advice. RESULTS: For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients. CONCLUSION: This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin-tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended.
INTRODUCTION: This guideline was written by a multidisciplinary committee with mandated members of the Dutch Society for Infectious Diseases, Dutch Society for Hematology, Dutch Society for Medical Oncology, Dutch Association of Hospital Pharmacists, Dutch Society for Medical Microbiology, and Dutch Society for Pediatrics. The guideline is written for adults and pediatric patients. METHOD: The recommendations are based on the answers to nine questions formulated by the guideline committee. To provide evidence-based recommendations we used all relevant clinical guidelines published since 2010 as a source, supplemented with systematic searches and evaluation of the recent literature (2010-2020) and, where necessary, supplemented by expert-based advice. RESULTS: For adults the guideline distinguishes between high- and standard-risk neutropenia based on expected duration of neutropenia (> 7 days versus ≤ 7 days). Where possible a distinction has been made between pediatric and adult patients. CONCLUSION: This guideline was written to aid diagnosis and management of patients with febrile neutropenia due to chemotherapy in the Netherlands. The guideline provides recommendation for children and adults. Adults patient are subdivided as having a standard- or high-risk neutropenic episode based on estimated duration of neutropenia. The most important recommendations are as follows. In adults with high-risk neutropenia (duration of neutropenia > 7 days) and in children with neutropenia, ceftazidime, cefepime, and piperacillin-tazobactam are all first-choice options for empirical antibiotic therapy in case of fever. In adults with standard-risk neutropenia (duration of neutropenia ≤ 7 days) the MASCC score can be used to assess the individual risk of infectious complications. For patients with a low risk of infectious complications (high MASCC score) oral antibiotic therapy in an outpatient setting is recommended. For patients with a high risk of infectious complications (low MASCC score) antibiotic therapy per protocol sepsis of unknown origin is recommended.
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