最近审阅: 27 十月 2020
最近更新: 27 十一月 2019

小结

定义

病史和体格检查

关键诊断因素

  • 近期化疗
  • 发热
  • 心动过速
  • 低血压

其他诊断因素

  • 年龄>65 岁
  • 既往化疗后中性粒细胞减少发作史
  • 东部肿瘤协作组体力状态 (ECOG PS) ≥1
  • 血液系统恶性肿瘤
  • 既往抗生素治疗方案
  • 白蛋白<35 g/L(<3.5 g/dL)
  • 治疗前血红蛋白 <120 g/L(<12 g/dL)
  • 第一轮化疗后中性粒细胞绝对计数的最低值较低(<500 cells/μl)
  • 异常呼吸音或咳嗽
  • 呼吸短促
  • 腹痛
  • 恶心或呕吐
  • 腹泻
  • 排尿困难和脓尿
  • 皮肤红斑、温热、压痛
  • 黏膜炎或口腔溃疡
  • 生殖器和肛门区域的感染、炎症或溃疡
  • 留置导管感染
  • 合并放疗
  • 感染暴露
  • 鼻窦压痛

危险因素

  • 年龄>65 岁
  • 白蛋白<35 g/L(<3.5 g/dL)
  • 已有的器官功能异常(心脏、肝脏、肾脏疾病)
  • 治疗前血红蛋白<120 g/L(<12 g/dL)
  • 足剂量化疗
  • 第一轮化疗后中性粒细胞绝对计数的最低值较低(<500 cells/μl)
  • 血液系统恶性肿瘤
  • 合并放疗
  • 既往化疗后中性粒细胞减少发作史
  • 女性
  • 东部肿瘤协作组全身功能状态评分 (ECOG PS) >1
  • 晚期疾病
  • 既往化疗
  • 皮质类固醇

诊断性检查

首要检查

  • 全血细胞计数和分类计数
  • 尿素和肌酐
  • 肝功能检查 (LFTs)
  • 细菌血培养:外周和中心静脉导管
  • 胸部 X 线检查
更多 首要检查

需考虑的检查

  • 粪便培养
  • 尿液培养
  • 腰椎穿刺术:
  • 真菌培养和血清学检测(β-葡聚糖和半乳甘露聚糖)
  • 病毒分子检测
  • 超声心动图
  • 胸部、腹部和盆腔 CT 检查
更多 需考虑的检查

治疗流程

撰稿人

Internist and Professor of Medicine

Department of Infectious Diseases, Infection Control and Employee Health

Division of Internal Medicine

The University of Texas M.D. Anderson Cancer Center

Houston

TX

利益声明

KVIR has research grants from Merck, Inc., Shionogi, and JMI Laboratories for the performance of in-vitro studies of novel antimicrobial agents.

Specialist in Infectious Disease & Internal Medicine

Infectious Disease Institute, Soroka Medical Center

Senior Lecturer, Faculty of Health Sciences

Ben-Gurion University of the Negev

Beer Sheba

Israel

利益声明

LN has given two educational lectures sponsored by MSD.

Dr Kenneth Rolston and Dr Lior Nesher would like to gratefully acknowledge Dr Caron Jacobson and Dr Joseph Antin, previous contributors to this topic.

利益声明

CJ and JA declare that they have no competing interests.

同行评议者展开全部内容

Price Eminent Scholar and Professor of Medicine

Director

Bone Marrow Transplant Program

Division of Hematology/Oncology

University of Florida College of Medicine

Gainesville

FL

利益声明

JW has been reimbursed by Pfizer, Merck, Astellas, and Enzon for speaking fees, fees for educational programs, and consulting.

Director

Alfa Institute of Biomedical Sciences

Marousi

Athens

Greece

利益声明

MF declares that he has no competing interests.

Senior Lecturer in Haematology

Honorary Consultant in Medical Oncology

St George's University of London

London

UK

利益声明

RP has received speaker fees and been reimbursed by Roche, Amgen, Chigai, and Bayer for attending several conferences. RP is a co-author of the EORTC guidelines referenced in this topic.

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