Fever and neutropenia in cancer patients: the diagnostic role of cytokines in risk assessment strategies.
Cancer patients treated with chemotherapy are susceptible to bacterial infections. Therefore, all neutropenic cancer patients with fever receive standard therapy consisting of broad-spectrum antibiotics and hospitalization. However, febrile neutropenia in cancer patients is often due to other causes than bacterial infections. Therefore, standard therapy should be re-evaluated and new treatment strategies for patients with variable risk for bacterial infection should be considered. This paper reviews the changing spectrum of microorganisms and resistance of microorganisms to antibiotics in infection during neutropenia and discusses new strategies for the selection of patients with low-risk for bacterial infection using clinical and biochemical parameters such as acute phase proteins and cytokines. These low-risk patients may be treated with alternative therapies such as oral antibiotics, early discharge from the hospital or outpatient treatment.
Oude Nijhuis
C S M
CS
Division of Pediatric Oncology, Beatrix Children's Hospital, University Hospital Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
Daenen
S M G J
SM
Vellenga
E
E
van der Graaf
W T A
WT
Gietema
J A
JA
Groen
H J M
HJ
Kamps
W A
WA
de Bont
Eveline S J M
ES
D000970:Antineoplastic Agents / Q000009:adverse effects; D016207:Cytokines / Q000276:immunology; D005334:Fever / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007109:Immunity / Q000235:genetics / Q000502:physiology; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy; D009894:Opportunistic Infections / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D018570:Risk Assessment
D000970:Antineoplastic Agents; D016207:Cytokines