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• W593491336 abstract "Infections in neutropenic patients still represent a great challenge since they often lack other signs of infection except fever, and infection rapidly can become fatal if not treated appropriately. Empirical treatment of those patients has already been shown to be very effective with a high overall response rate (RR) of more than 90%. However, patients with pneumonia have a much lower RR and survival when treated with anti-microbial therapy. In addition, a significant proportion of patients, which do not respond to first or second line therapy have persistent fever for many days, which might result in worsening of the general condition and prolongation of chemotherapy treatment. Therefore improvement of sequential treatment strategies is necessary. The PEG study group initiated 3 studies (PEG I-III), in which efficacy of a three step interventional treatment strategy for high-risk neutropenic patients with fever of unknown origin (FUO) and documented infections was investigated. In the PEG II study 767 patients with FUO and 90%) could be achieved with a stepwise supplementation and modification of treatment. RR to first line therapy with piperacillin plus aminoglycoside or ceftazidim/cefotaxim plus aminoglycoside could not be improved in PEG II compared to the previous PEG I study (RR=65%). However, for non-responders additional antifungal therapy with amphotericin-B (RR=78%) or fluconazol (RR=63%) significantly (p=0,03) improved RR compared to antibacterial therapy alone (RR=56%, 78% vs. 56%, p=0,03); and the time until patients responded to an empirical treatment was shortened. In addition, it was demonstrated, that in comparison to PEG I, empirical amphotericin-B treatment should be additionally given in patients with lung infiltrates (RR=76% vs. 61%). Based on these results the PEG III study was recently initiated with the following objectives: Can the results of the first line therapy be improved by using piperacillin/tazobactam plus aminoglycosides and will the RR persist with monotherapy (carbapenem or cefepime). In addition, since the important role of antifungals in second line treatment was demonstrated: is therapy with amphotericin-B more effective compared to fluconazole?" @default.
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• W593491336 date "2001-01-01" @default.
• W593491336 modified "2023-10-12" @default.
• W593491336 title "Empirical Antimicrobial Therapy of FUO and Proved Infections in Neutropenic Patients" @default.
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• W593491336 doi "https://doi.org/10.1007/978-3-642-18156-6_53" @default.
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