抗菌药物在中性粒细胞缺乏并发感染的合理应用

Rational Antibiotics Therapy in Febrile Neutropenia

中性粒细胞缺乏并发感染是化疗后常见并发症,治疗延迟或抗菌药物选择不合理常导致病死率上升。本文就近年来中性粒细胞缺乏合并感染性发热临床微生物学变迁、开始抗菌药物治疗前临床评估、抗菌药物选择及方案优化等临床常见问题结合新近临床试验的循证医学证据进行分析,探讨抗菌药物合理应用方案。

Objective Febrile neutropenia is a common complication after chemotherapy. Delayed antibiotics treatment or inadequate antibiotics treatment may increase the risk of death. Recent clinical microbiology investigations showed increasing rate of antibiotics resistance and incidence of Gram positive bacilli infection. There are no first - line therapy in febrile neutropenia. In this review, we analyzed recent clinical trials and meta - analysis which showed antibiotics monotherapy was as effective as combination therapy. Vancomycin did not change the outcomes when combined with 13 - lactam antibiotics as first line empirical therapy even though clinical microbiology showed increasing incidence of G ^＊ bacilli infection. New antifungal agents may functions better than amphotericin B, Based on evidence - based data from clinical trials, febrile neutropenia can be treated more rational than empirical.