MANAGEMENT OF INFECTIONS DURING INTENSIVE TREATMENT OF HEMATOLOGIC MALIGNANCIES

In febrile neutropenic patients with high-grade hematologic malignanci es, empirical antimicrobial intervention is mandatory. Large randomize d clinical trials have elucidated the benefit of broad-spectrum beta l actam antibiotics used as single drugs or in combination with aminogly cosides in order to provide activity against gram-negative aerobes as well as against streptococci and Staphylococcus aureus. As a result, i nfection-related mortality was reduced to less than 10% also in patien ts undergoing intensified remission induction or consolidation therapy for acute leukemias. Distinct subgroups of patients have been identif ied who need an empirical modification of antimicrobial treatment, i.e ., patients with catheter-related infections, patients with pulmonary infiltrates, and patients with unexplained fever not responding to fir st-line antibiotics. In two consecutive, prospectively randomized tria ls conducted by the Paul Ehrlich Society it was demonstrated that empi rical antifungal therapy is beneficial for second-line treatment in pa tients with persistent unexplained fever and should be part of the fir st-line approach in patients with lung infiltrates. The empirical addi tion of glycopeptides, however, should be restricted to patients with catheter-related infections due to coagulase-negative staphylococci.