title: Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology.
abstract: Patients with neutropenia lasting for more than 10d, who develop fever and pulmonary infiltrates, are at risk of treatment failure under conventional broad-spectrum antibacterial therapy. Filamentous fungi are predominant causes of failure, however, multi-resistant gram-negative rods such as Pseudomonas aeruginosa or Stenotrophomonas maltophilia may be involved. Prompt addition of mould-active systemic antifungal therapy, facilitated by early thoracic computed tomography, improves clinical outcome. Non-culture-based diagnostic procedures to detect circulating antigens such as galactomannan or 1,3-beta-d-glucan, or PCR techniques to amplify circulating fungal DNA from blood, bronchoalveolar lavage or tissue specimens, may facilitate the diagnosis of invasive pulmonary aspergillosis. CT-guided bronchoalveolar lavage is useful in order to identify causative microorganisms such as multidrug-resistant bacteria, filamentous fungi or Pneumocystis jiroveci. For pre-emptive antifungal treatment, voriconazole or liposomal amphotericin B is preferred. In patients given broad-spectrum azoles for antifungal prophylaxis, non-azole antifungals or antifungal combinations might become first choice in this setting. Antifungal treatment should be continued for at least 14 d before non-response and treatment modification are considered. Microbial isolates from blood cultures, bronchoalveolar lavage or respiratory secretions must be critically interpreted with respect to their aetiological relevance for pulmonary infiltrates.
authors.affiliation: Klinikum Ernst von Bergmann, Dept. of Haematology and Oncology, Charlottenstrasse 72, Potsdam D-14467, Germany. gmaschmeyer@klinikumevb.de
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Beinert
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Werner
authors.initials: W
authors.lastname: Heinz
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.forename: Christoph
authors.initials: C
authors.lastname: Kahl
authors.forename: Michael
authors.initials: M
authors.lastname: Kiehl
authors.forename: Joachim
authors.initials: J
authors.lastname: Lorenz
authors.forename: Herbert
authors.initials: H
authors.lastname: Hof
authors.forename: Gloria
authors.initials: G
authors.lastname: Mattiuzzi
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005334:Fever / Q000150:complications / Q000188:drug therapy; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D000935:Antifungal Agents