Purpose of review
This review provides an update on microbiological and therapeutic data in febrile neutropenic patients in general and those with bacterial lung
sepsis in particular. Although the Infectious Diseases Society of America updated its guidelines on febrile neutropenia
in 2010, changing epidemiological factors and the spread of new drug resistance constitutes challenges for initial treatment
of this condition.
Recent findings Lung
sepsis stands out because of the frequent absence of microbiological identification. We review the use of newly available, novel, broad-spectrum antibiotics (linezolid, tigecycline, daptomycin, etc.) in this indication.
Although the incidence of Gram-negative infections in neutropenic fever is leveling off, there is a worrying increase in resistance. New drugs are available but not well studied in febrile neutropenia
; daptomycin and tigecycline should not be used in suspected lung
sepsis in these patients. New diagnostic tools (such as the procalcitonin assay and the LightCycler SeptiFast assay, Roche Molecular Systems) appear to be unhelpful in febrile neutropenia
, although more data on fungal sepsis are required. There are no specific features of the treatment
of pneumonia or septic shock in neutropenic fever, but both conditions increase the mortality rate.