Neutropenia Febril

Descripción General

Definición

La neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia febril se define como una temperatura oral única > 38.3 ℃ (100.9 ℉) o una temperatura > 38.0 ℃ (100.4 ℉) durante al AL Amyloidosis menos 1 hora con un recuento absoluto de neutrófilos <1500 células / µL o un recuento absoluto de neutrófilos que se espera que disminuya a <500 células / µL durante las próximas 48 horas.

Epidemiología

• La neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia febril se desarrolla en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • 10%–50% de pacientes con tumores sólidos
  • 80% de los LOS Neisseria pacientes con tumores hematológicos
• El 50% de los LOS Neisseria pacientes desarrollará una infección.
• Fuente de infección evidente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 20%–30% de los LOS Neisseria casos
• El examen/cultivo no detectan focos/patógenos infecciosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 30%–60% de los LOS Neisseria casos.
• El 80% de las infecciones provienen de la flora bacteriana normalmente benigna o comensal del paciente.
• Los LOS Neisseria sitios comunes de infección incluyen:
  • Pulmón
  • Piel
  • Sangre
  • Tracto gastrointestinal

Etiología

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria casos, se desconoce el origen de la infección (lo que se conoce como fiebre de origen desconocido). La mayoría de las infecciones documentadas son bacterianas.

Las fuentes comunes de bacteriemia son:

• Translocación de bacterias entéricas al AL Amyloidosis torrente sanguíneo
• Infecciones del torrente sanguíneo relacionadas con el catéter

Patógenos bacterianos comunes:

• Gram positivos (representan más de la ½ de los LOS Neisseria casos):
  • Estafilococos coagulasa negativos (más común)
    • Staphylococcus epidermidis Staphylococcus epidermidis A species of staphylococcus that is a spherical, non-motile, gram-positive, chemoorganotrophic, facultative anaerobe. Mainly found on the skin and mucous membrane of warm-blooded animals, it can be primary pathogen or secondary invader. Staphylococcus
    • Staphylococcus Staphylococcus Staphylococcus is a medically important genera of Gram-positive, aerobic cocci. These bacteria form clusters resembling grapes on culture plates. Staphylococci are ubiquitous for humans, and many strains compose the normal skin flora. Staphylococcus haemolyticus
  • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess (incluido MRSA MRSA A strain of Staphylococcus aureus that is non-susceptible to the action of methicillin. The mechanism of resistance usually involves modification of normal or the presence of acquired penicillin binding proteins. Staphylococcus, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • Enterococos (incluidos los LOS Neisseria resistentes a la vancomicina)
  • Estreptococos del grupo viridans
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus pyogenes
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus pneumoniae
  • Especies de Bacillus Bacillus Bacillus are aerobic, spore-forming, gram-positive bacilli. Two pathogenic species are Bacillus anthracis (B. anthracis) and B. cereus. Bacillus
• Gram-negativos:
  • Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli
  • Pseudomonas aeruginosa Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas
  • Especies de Klebsiella Klebsiella Klebsiella are encapsulated gram-negative, lactose-fermenting bacilli. They form pink colonies on MacConkey agar due to lactose fermentation. The main virulence factor is a polysaccharide capsule. Klebsiella pneumoniae is the most important pathogenic species. Klebsiella
  • Enterobacter Enterobacter Multidrug-resistant Organisms and Nosocomial Infections
  • Fusobacterium Fusobacterium A genus of gram-negative, anaerobic, rod-shaped bacteria found in cavities of humans and other animals. No endospores are formed. Some species are pathogenic and occur in various purulent or gangrenous infections. Dog and Cat Bites
  • Especies de Acinetobacter Acinetobacter Multidrug-resistant Organisms and Nosocomial Infections
  • Stenotrophomonas maltophilia

Patógenos fúngicos comunes:

• Especies de Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins
• Especies de Cándida
• Especies de Fusarium
• Hongos endémicos

Patógenos virales comunes:

• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections
• Citomegalovirus
• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology influenza Influenza Influenza viruses are members of the Orthomyxoviridae family and the causative organisms of influenza, a highly contagious febrile respiratory disease. There are 3 primary influenza viruses (A, B, and C) and various subtypes, which are classified based on their virulent surface antigens, hemagglutinin (HA) and neuraminidase (NA). Influenza typically presents with a fever, myalgia, headache, and symptoms of an upper respiratory infection. Influenza Viruses/Influenza
• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology parainfluenza
• Adenovirus Adenovirus Adenovirus (member of the family Adenoviridae) is a nonenveloped, double-stranded DNA virus. Adenovirus is transmitted in a variety of ways, and it can have various presentations based on the site of entry. Presentation can include febrile pharyngitis, conjunctivitis, acute respiratory disease, atypical pneumonia, and gastroenteritis. Adenovirus
• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology sincitial respiratorio

Otros patógenos comunes:

• Strongyloides stercoralis Strongyloides stercoralis A species of parasitic nematode widely distributed in tropical and subtropical countries. The females and their larvae inhabit the mucosa of the intestinal tract, where they cause ulceration and diarrhea. Strongyloidiasis
• Especies de Leishmanias
• Esepecies de Trypanosoma

Fisiopatología

La combinación de los LOS Neisseria siguientes factores contribuye al AL Amyloidosis desarrollo de fiebre neutropénica:

• Supresión de la médula ósea inducida por quimioterapia
• Reemplazo metastásico de médula ósea
• Producción/aclaramiento anormal de anticuerpos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cánceres productores de anticuerpos (e.g., mieloma múltiple, leucemia linfocítica crónica), lo que da como resultado asplenia Asplenia Asplenia is the absence of splenic tissue or function and can stem from several factors ranging from congenital to iatrogenic. There is a distinction between anatomic asplenia, which is due to the surgical removal of the spleen, and functional asplenia, which is due to a condition that leads to splenic atrophy, infarct, congestion, or infiltrative disease. Asplenia funcional
• Producción y función anormal de celulas T (linfoma)
• Lesión de la mucosa inducida por quimioterapia
• Presencia de fuentes de infección (catéteres)

Presentación Clínica

La neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia puede minimizar los LOS Neisseria síntomas y signos de infección:

• Activación de neutrófilos responsable de muchos síntomas inflamatorios de infección.
• Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia → ↓ activación de neutrófilos → ↓ liberación de citocinas → ↓ síntomas inflamatorios

La presencia de fiebre puede ser el único signo de infección.

Los LOS Neisseria síntomas comunes de la neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia febril son:

• Odinofagia
• Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la boca
• Úlceras cutáneas
• Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome
• Disnea
• Disuria
• Frecuencia y urgencia urinaria
• Enrojecimiento y sensibilidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el sitio del catéter.

Diagnóstico

Todos los LOS Neisseria pacientes con neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia febril deben someterse a una evaluación de los LOS Neisseria antecedentes y un examen físico detallados. Se deben realizar estudios de diagnóstico.

Antecedentes

Una anamnesis detallada debe incluir:

• Revisión de sistemas para localizar un foco de infección
• Medicamentos actuales
• Tipo de cáncer
• Régimen de quimioterapia actual
• Revise cualquier prueba de laboratorio reciente, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular los LOS Neisseria estudios hematológicos.
• Presencia de alergias
• Uso de esteroides
• Comorbilidades
• Antecedentes previos de infecciones.
• Profilaxis reciente con antibióticos
• Administración reciente de factores de crecimiento hematopoyéticos
• Antecedentes de trasplante

Examen físico

Un examen físico completo debe incluir una evaluación de:

• Piel:
  • Eritema
  • Sensibilidad
  • Úlceras
  • Abscesos
  • Sitios de inserción de catéteres centrales
  • Ectima gangrenoso (visto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infección por P. aeruginosa P. aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas )
• Fondo de ojo: signos de émbolos sépticos
• Senos paranasales
  • Sensibles
  • Apariencia “pantanosa” (azulada, pálida, hinchada)
• Boca:
  • Úlceras
  • Enfermedad periodontal
  • Leucoplasia
• Pulmones
• Abdomen:
  • Examen de la mucosa visceral
  • No realizar un examen rectal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes neutropénicos.
• Área perineal:
  • Quiste pilonidal
  • Absceso perirrectal
  • Infección vaginal/vulvar
• Sistema neurológico:
  • Meningismo
  • Déficit neurológico focal
  • Estado mental alterado
• Sitios de catéter:
  • Eritema
  • Fluctuación
  • Sensibilidad
  • Cordón palpable a lo largo de la vena

Pruebas de diagnóstico

Estudios de laboratorio:

• Hemograma/Diferencial:
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia grave: Recuento absoluto de neutrófilos < 500 células / µL
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia profunda: Recuento absoluto de neutrófilos < 100 células / µL
• Tipo de sangre
• Pruebas de coagulación
• Química sanguínea:
  • Función renal
  • Función hepática
  • Electrolitos
• Lactato: los LOS Neisseria niveles elevados sugieren sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock.
• Análisis de orina
• Proteína C reactiva
• Tasa de sedimentación de eritrocitos
• Procalcitonina:
  • Prohormona de la calcitonina, producida durante la infección sistémica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum respuesta a toxinas microbianas y mediadores inflamatorios del huésped
  • Puede ayudar a diferenciar la etiología infecciosa de la no infecciosa de la fiebre:
    • Elevada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infección bacteriana
    • Elevada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infección fúngica
  • Puede ayudar a guiar la selección y la duración de la terapia antibiótica:
    • Refuerza la decisión de iniciar los LOS Neisseria antibióticos si son elevados
    • Refuerza la decisión de retener/retirar los LOS Neisseria antibióticos si no están elevados
  • Puede ayudar a evitar un tratamiento antibiótico innecesario o prolongado

Cultivos:

• Hemocultivos:
  • Deben obtenerse 2 muestras de hemocultivos de 2 sitios de punción venosa periférica separados y de cualquier catéter venoso presente.
  • 1 set consta de 2 frascos (aeróbico y anaeróbico).
• Debe obtenerse un urocultivo si:
  • El paciente está sintomático
  • El paciente tiene antecedentes de infección del tracto urinario.
  • Un catéter está presente
• Cultivo específico de un sitio
  • Microscopía y coprocultivo si hay diarrea ( Clostridium difficile Clostridium difficile A common inhabitant of the colon flora in human infants and sometimes in adults. The type species clostridioides difficile is formerly known as Clostridium difficile. It is a causative agent for clostridioides infections and is associated with pseudomembranous enterocolitis in patients receiving antibiotic therapy. Clostridia)
  • Microscopía y cultivo de esputo si hay signos de infección respiratoria.
  • Hisopo para piel/heridas

Imagenología:

• Se debe obtener una radiografía de tórax o una tomografía computarizada (TC).
• Se debe realizar más imagenología cuando esté clínicamente indicado.

Tratamiento

Abordaje general

• Consideraciones de evaluación de riesgos:
  • Puntuación de la Multinational Association for Supportive Care in Cancer (Asociación Multinacional para el Cuidado de Apoyo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el Cáncer (MASCC, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés))
  • Paciente apropiado para el tratamiento ambulatorio versus hospitalario
  • Paciente apropiado para antibióticos orales versus intravenosos
  • Duración prevista de la terapia
  • Disponibilidad del cuidador
• Pacientes de bajo riesgo:
  • Duración de la neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia ≤ 7 días
  • Sin comorbilidades
  • Funcionalismo hepático y renal normales
  • Puntuación MASCC ≥ 21
• Pacientes de alto riesgo:
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia profunda (Recuento total de neutrófilos ≤ 100 células/µL)
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia prolongada (≥ 7 días)
  • Profilaxis actual con fluoroquinolonas
  • Puntuación MASCC < 21
  • Condiciones comórbidas:
    • Dolor Dolor Inflammation abdominal de nueva aparición
    • Hipotensión
    • Neumonía
    • Cambios neurológicos
    • Evidencia de disfunción orgánica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria laboratorios
    • Inestabilidad hemodinámica
• La terapia empírica debe administrarse dentro de 1 hora después del ingreso.
• Selección de antibióticos empíricos:
  • Adaptado a la fuente de infección conocida/sospechada
  • Antibiótico betalactámico antipseudomonas para pacientes que ya reciben profilaxis con fluoroquinolonas
  • Si se desconoce la fuente:
    • Cobertura de amplio espectro
    • Considere la posibilidad de realizar una interconsulta con infectología

Pacientes de bajo riesgo

Los LOS Neisseria pacientes de bajo riesgo se tratan como pacientes ambulatorios o inicialmente como pacientes hospitalizados y luego se transfieren a pacientes ambulatorios con un seguimiento estrecho (terapia con antibióticos por vía oral).

• Sin alergia a la penicilina: levofloxacino/ciprofloxacino más amoxicilina–clavulanato
• Alergia a la penicilina: clindamicina más levofloxacino/ciprofloxacino
• Otros: monoterapia con moxifloxacino
• Inicialmente, no se recomienda ningún tratamiento antimicótico.
• Se deben administrar antifúngicos de amplio espectro si la fiebre persiste ≥ 4–7 días.

Pacientes de alto riesgo

Los LOS Neisseria pacientes de alto riesgo deben ser tratados como pacientes hospitalizados (terapia con antibióticos por vía intravenosa).

• Sin alergia a la penicilina:
  • Piperacilina– tazobactam Tazobactam A penicillanic acid and sulfone derivative and potent beta-lactamase inhibitor that enhances the activity of other anti-bacterial agents against beta-lactamase producing bacteria. Cephalosporins
  • Meropenem Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than imipenem, but does not need to be given with an enzyme inhibitor such as cilastatin. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. Carbapenems and Aztreonam
  • Imipenem Imipenem Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. Carbapenems and Aztreonam–cilastatina
  • Cefepima
• Caso complicado o resistencia a los LOS Neisseria antibióticos: Se deben agregar aminoglucósidos a los LOS Neisseria regímenes anteriores.
  • Gentamicina
  • Amikacina
  • Tobramicina
• Alergia a la penicilina:
  • Sin profilaxis con fluoroquinolonas: ciprofloxacina más clindamicina
  • Con profilaxis con fluoroquinolonas: aztreonam Aztreonam The carbapenems and aztreonam are both members of the bactericidal beta-lactam family of antibiotics (similar to penicillins). They work by preventing bacteria from producing their cell wall, ultimately leading to bacterial cell death. Carbapenems and Aztreonam más vancomicina
• Pacientes con enterocolitis Enterocolitis Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses. Yersinia spp./Yersiniosis neutropénica:
  • Piperacilina– tazobactam Tazobactam A penicillanic acid and sulfone derivative and potent beta-lactamase inhibitor that enhances the activity of other anti-bacterial agents against beta-lactamase producing bacteria. Cephalosporins
  • Carbapenem Carbapenem The carbapenems and aztreonam are both members of the bactericidal beta-lactam family of antibiotics (similar to penicillins). They work by preventing bacteria from producing their cell wall, ultimately leading to bacterial cell death. Carbapenems and Aztreonam
  • Cefalosporina antipseudomonica más metronidazol
• Organismos resistentes a antibióticos:
  • S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus resistente a la meticilina:
    • Daptomicina
    • Linezolid Linezolid An oxazolidinone and acetamide derived anti-bacterial agent and protein synthesis inhibitor that is used in the treatment of gram-positive bacterial infections of the skin and respiratory tract. Oxazolidinones
    • Vancomicina
  • Enterococos resistentes a la vancomicina:
    • Daptomicina
    • Linezolid Linezolid An oxazolidinone and acetamide derived anti-bacterial agent and protein synthesis inhibitor that is used in the treatment of gram-positive bacterial infections of the skin and respiratory tract. Oxazolidinones
  • Betalactamasa de espectro extendido:
    • Un carbapenémico
  • Carbapenemasa de Klebsiella pneumoniae Klebsiella Pneumoniae Gram-negative, non-motile, capsulated, gas-producing rods found widely in nature and associated with urinary and respiratory infections in humans. Aminoglycosides:
    • Polimixina B
    • Colistina
    • Tigeciclina
• Indicaciones de adición de vancomicina:
  • Inestabilidad hemodinámica
  • Neumonía
  • Hemocultivos positivos para bacterias grampositivas
  • Infección de piel o tejidos blandos
  • Infección relacionada con el catéter
  • Colonización con MRSA MRSA A strain of Staphylococcus aureus that is non-susceptible to the action of methicillin. The mechanism of resistance usually involves modification of normal or the presence of acquired penicillin binding proteins. Staphylococcus, Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus resistente a penicilina
• Terapia antifúngica:
  • Indicaciones:
    • El paciente es inestable y
    • La fiebre persiste ＞ 4–7 días
  • Medicamentos:
    • Anfotericina B (aspergilosis invasiva)
    • Voriconazol (aspergilosis invasiva)
    • Itraconazol
    • Posaconazol
    • Caspofungina ( candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis)
    • Micafungina
• Terapia antiviral Antiviral Antivirals for Hepatitis B:
  • Indicaciones:
    • Enfermedad viral activa con herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections/varicela zoster
    • Trasplante de médula ósea reciente/actual
  • Medicamentos
    • Aciclovir para el herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections
    • Aciclovir para la varicela zoster
    • Inhibidores de la neuraminidasa para influenza Influenza Influenza viruses are members of the Orthomyxoviridae family and the causative organisms of influenza, a highly contagious febrile respiratory disease. There are 3 primary influenza viruses (A, B, and C) and various subtypes, which are classified based on their virulent surface antigens, hemagglutinin (HA) and neuraminidase (NA). Influenza typically presents with a fever, myalgia, headache, and symptoms of an upper respiratory infection. Influenza Viruses/Influenza probable/confirmada

Duración de la terapia

• Se identifica la fuente de infección:
  • Duración adecuada del tratamiento para esa infección en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular y
  • Recuento absoluto de neutrófilos ≥ 500 células/µL
• Fuente de infección desconocida:
  • Fiebre resuelta por ≥ 48 horas y
  • Recuento absoluto de neutrófilos ≥ 500 células/µL

Terapia de soporte

• Líquidos intravenosos
• No se recomienda la administración de factores estimulantes de colonias
• Indicaciones para la extracción del catéter permanente:
  • Infección del túnel del catéter o de la bolsa del puerto
  • Sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock (si se desconoce la fuente infecciosa)
  • Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis
  • Émbolos sépticos
  • Infección que persiste> 72 horas a pesar de la terapia con antibióticos
  • Infección causada por:
    • S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus
    • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus
    • Hongos
    • Micobacterias no tuberculosas

Profilaxis

• Indicaciones:
  • Pacientes de alto riesgo
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia profunda
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia prolongada
• Medicamentos:
  • Levofloxacina
  • Ciprofloxacina
  • Azoles Azoles Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Azoles
  • Trimetoprima-sulfametoxazol (neumonía por Pneumocystis jirovecii)

Diagnóstico Diferencial

• Reacción a la transfusión: complicación de las terapias transfusionales (hemoderivados/sangre total). La reacción a la transfusión se manifiesta con fiebre, escalofríos, urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives), prurito, disnea, hipotensión y dificultad respiratoria. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la aparición de síntomas durante o después de la transfusión. El tratamiento incluye la interrupción de la transfusión, la administración de líquidos intravenosos, antihistamínicos y antipiréticos.
• Fiebre neoplásica: síndrome paraneoplásico causado por ciertas neoplasias malignas (principalmente hematológicas). El único síntoma de presentación es fiebre, sin signos de infección o reacción a medicamentos. La fiebre neoplásica es un diagnóstico de exclusión. La administración de naproxeno puede suprimir la temperatura. El tratamiento incluye el tratamiento de la neoplasia maligna subyacente y el control de los LOS Neisseria síntomas con AINE, acetaminofén y corticosteroides.