Respiratory disease in neutropenic patients: diagnosis and treatment

RESUMO

The associations between malignancy, immunossupression and infectious morbidity and mortality have been established, and the use of more intensive chemotherapic regimens have produced a higher number of immunosuppressed oncologic patients. Thus, the benefits of the antineoplastic therapy can be limited by the mortality associated with the complications of life-threatening infection. This have raised the necessity of empiric therapy, which main goal is to prevent the death in the carly stage, until a more specific choice can be determined based on the results of the bacteriological examination and the patient's response. Pulmonary infiltrates, which are generally the first manifestation of respiratory infection in immunocompromised patients, can be classified as localized (early, refractory or late) or diffuse. this classification helps to establish more directed empiric approaches. The choices of the initial empiric antibiotic therapy include (a) aminoglycoside + extended-spectrum beta-lactam, (b) complication of 2 beta-lactams, or (c) extended-spectrum monotherapy. It is also possible to coadministrate speciffically oriented. The optimal duration of empiric therapy and empiric antifungal therapy are also discussed in this review. The prevention of pulmonary infections is justified by the reduction in the morbidity, mortality, and hospital costs. Selective decontamination with the use of agents that preserve the anaerobic flora have had variable results, being SMZ/TMP the agent more commonly used for this purpose. Hemotopoietic growth factors have shown to be effective in reducing the duration and the severity, but not the incidence of the chemotherapy-associated neutropenia, the number of infection episodes, or the mortally associated to infection.