title: [Febrile neutropenia in onco-hematology patients hospitalized in Intensive Care Unit].
abstract: Febrile neutropenia in cancer patients is associated with a high mortality. Patients are frequently admitted to Intensive Care Unit (ICU) for severe sepsis or septic shock. Empirical antibiotic treatment, including monotherapy β-lactam covering Pseudomonas aeruginosa, must be prompt. The ICU management is slightly different, due to a particular microbial ecology. A standardized approach to obtain a microbiological documentation is the cornerstone in these patients, leading to an adapted antimicrobial treatment. Systematic reassessment of initial antibiotic regimen should be realised. Neutropenic patients with severe sepsis or septic shock should receive promptly a β-lactam-aminoglycoside combination, as well as glycopeptides in case of severity or absence of documented infection. Early catheter removal should be considered widely. In the actual context of growing resistance, antibiotics saving became a major concern. According to context and microbial documentation, an escalade or de-escalade approach is recommended, to take into account multi-resistant pathogens. The addition of antifugal treatment is also a major issue in these patients and has well-defined indications. In neutropenic patients admitted in the ICU for severe sepsis or septic shock, controlling local microbial epidemiology and the emergence of multi-resistant bacteria are the key issues.
authors: Institut Paoli-Calmette, département d'hématologie, 13273 Marseille cedex 9, France.
authors: Colombe
authors: C
authors: Saillard
authors: Institut Paoli-Calmette, département d'anesthésie réanimation, 13273 Marseille cedex 9, France.
authors: Antoine
authors: A
authors: Sannini
authors: Institut Paoli-Calmette, département d'anesthésie réanimation, 13273 Marseille cedex 9, France.
authors: Laurent
authors: L
authors: Chow-Chine
authors: Institut Paoli-Calmette, département d'anesthésie réanimation, 13273 Marseille cedex 9, France.
authors: Jean-Louis
authors: JL
authors: Blache
authors: Institut Paoli-Calmette, département d'anesthésie réanimation, 13273 Marseille cedex 9, France.
authors: Jean-Paul
authors: JP
authors: Brun
authors: Institut Paoli-Calmette, département d'anesthésie réanimation, 13273 Marseille cedex 9, France. Electronic address: mokartd@ipc.unicancer.fr.
authors: Djamel
authors: D
authors: Mokart
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy; D003422:Critical Care; D024901:Drug Resistance, Multiple, Bacterial; D064147:Febrile Neutropenia / Q000150:complications / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D011552:Pseudomonas Infections / Q000188:drug therapy; D018805:Sepsis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000998:Antiviral Agents
keywords: Antibiothérapie empirique; Empirical antibiotic treatment; Febrile neutropenia; Guidelines; Intensive care unit; Neutropénie fébrile; Onco-hematology patients; Patient d’onco-hématologie; Recommandations; Réanimation