Resumen de Protocolo diagnóstico de las complicaciones febriles del paciente neutropénico

A. Sánchez Salinas, M. F. Ibáñez Camacho, Valentín Cabañas Perianes, José María Moraleda Jiménez

• español

  Las complicaciones infecciosas constituyen una importante causa de morbimortalidad en los pacientes oncohematológicos, especialmente durante los períodos de neutropenia inducida por quimioterapia. La administración precoz de antibióticos de amplio espectro de forma empírica es una práctica consolidada en el tratamiento de la neutropenia febril. Es necesario hacer el diagnóstico diferencial con otras posibles causas de fiebre en el paciente neutropénico (enfermedad de base, síndrome de lisis tumoral, fármacos, transfusiones, etc.], y evaluar el riesgo de complicaciones graves. Para ello se realizará una historia clínica completa y exploraciones complementarias básicas que nos ayudarán a determinar el tipo de terapia antibiótica y su posología (oral o intravenosa), el lugar del tratamiento (hospitalización o ambulatorio) y su duración. Se debe buscar la localización del foco infeccioso y su documentación microbiológica siempre que sea posible mediante el cultivo de muestras biológicas.

• English

  Infectious complications are a major cause of morbidity and mortality in oncohematological patients, especially during chemotherapy-induced neutropenia. Early empirical administration of broad-spectrum antibiotics is the standard practice in the treatment of febrile neutropenia. We have to make the differential diagnosis with other causes of fever in neutropenic patients (underlying disease, tumor Iysis syndrome, drugs, transfusions, etc) and to evaluate the risk of severe infection complications. A complete medical history with physical examination and basic laboratory tests are neccesary to determine the type of empirical antibiotic treatment (oral versus intravenous), its duration, and if the patient needs to be admitted to the hospital (inpatient versus outpatient treatment). It is also important to investigate the source of infection and to get a microbiological documentation. Infectious complications are a major cause of morbidity and mortality in oncohematological patients, especially during chemotherapy-induced neutropenia. Early empirical administration of broad-spectrum antibiotics is the standard practice in the treatment of febrile neutropenia. We have to make the differential diagnosis with other causes of fever in neutropenic patients (underlying disease, tumor Iysis syndrome, drugs, transfusions, etc) and to evaluate the risk of severe infection complications. A complete medical history with physical examination and basic laboratory tests are neccesary to determine the type of empirical antibiotic treatment (oral versus intravenous), its duration, and if the patient needs to be admitted to the hospital (inpatient versus outpatient treatment). It is also important to investigate the source of infection and to get a microbiological documentation.