TdC 318: Neutropenia febril - 5 Clinicagens

Notas do episódio

https://www.tadeclinicagem.com.br/guia/ Confira a promoção especial para o plano anual do Guia TdC: Receba em casa o Card de Consulta Rápida no Plantão, com os temas: IOT, ACLS, ATB, ECG, trombólise e reposição eletrolítica. Receba em casa o porta-crachá (tirante para crachá) do TdC. Ganhe R$ 50 OFF (de 449 por 399,00) 7 primeiros dias inteiramente grátis Use o CUPOM: GUIADZERO Iaaaago Jorge convida Raphael Barreto e Lucas Brandão para discutir sobre neutropenia febril, em 5 clinicagens: 1. Neutropenia febril é emergência oncológica 2. Como escolher o antibiótico? 3. Quando escalonar o antibiótico? 4. Quando suspender o antibiótico? 5. Quando prescrever filgrastim? Referências: 1. Klastersky J, de Naurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016;27(suppl 5):v111-v118. doi:10.1093/annonc/mdw325 2. Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211 3. Zhang H, Wu Y, Lin Z, et al. Naproxen for the treatment of neoplastic fever: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2019;98(22):e15840. doi:10.1097/MD.0000000000015840 4. Zheng B, Huang Z, Huang Y, Hong L, Li J, Wu J. Predictive value of monocytes and lymphocytes for short-term neutrophil changes in chemotherapy-induced severe neutropenia in solid tumors. Support Care Cancer. 2020;28(3):1289-1294. doi:10.1007/s00520-019-04946-3 5. Douglas C, Morse JD, Anderson BJ. Mucositis Pain and Its Temporal Relationship to White Cell Count. Paediatr Anaesth. 2025;35(4):302-309. doi:10.1111/pan.15063 6. Vassallo M, Michelangeli C, Fabre R, et al. Procalcitonin and C-Reactive Protein/Procalcitonin Ratio as Markers of Infection in Patients With Solid Tumors. Front Med (Lausanne). 2021;8:627967. Published 2021 Mar 12. doi:10.3389/fmed.2021.627967 7. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488 8. Heil G, Hoelzer D, Sanz MA, et al. A randomized, double-blind, placebo-controlled, phase III study of filgrastim in remission induction and consolidation therapy for adults with de novo acute myeloid leukemia. The International Acute Myeloid Leukemia Study Group. Blood. 1997;90(12):4710-4718. 9. Weiss JM, Csoszi T, Maglakelidze M, et al. Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial. Ann Oncol. 2019;30(10):1613-1621. doi:10.1093/annonc/mdz278 10. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64(2):328-340. doi:10.7326/0003-4819-64-2-328 11. Nucci M, Arrais-Rodrigues C, Bergamasco MD, et al. Management of febrile neutropenia: consensus of the Brazilian Association of Hematology, Blood Transfusion and Cell Therapy - ABHH. Hematol Transfus Cell Ther. 2024;46 Suppl 6(Suppl 6):S346-S361. doi:10.1016/j.htct.2024.11.119 12. Guarana M, Nucci M, Nouér SA. Shock and Early Death in Hematologic Patients with Febrile Neutropenia. Antimicrob Agents Chemother. 2019;63(11):e01250-19. Published 2019 Oct 22. doi:10.1128/AAC.01250-19 13. Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother. 2014;58(7):3799-3803. doi:10.1128/AAC.02561-14 14. Averbuch D, Orasch C, Cordonnier C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013;98(12):1826-1835. doi:10.3324/haematol.2013.091025 15. Beyar-Katz O, Dickstein Y, Borok S, Vidal L, Leibovici L, Paul M. Empirical antibiotics targeting gram-positive bacteria for the treatment of febrile neutropenic patients with cancer. Cochrane Database Syst Rev. 2017;6(6):CD003914. Published 2017 Jun 3. doi:10.1002/14651858.CD003914.pub4 16. Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, et al. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies. Clin Microbiol Infect. 2019;25(4):447-453. doi:10.1016/j.cmi.2018.07.026 17. Ljungman P, Alain S, Chemaly RF, et al. Recommendations from the 10th European Conference on Infections in Leukaemia for the management of cytomegalovirus in patients after allogeneic haematopoietic cell transplantation and other T-cell-engaging therapies. Lancet Infect Dis. 2025;25(8):e451-e462. doi:10.1016/S1473-3099(25)00069-6 18. Maertens J, Lodewyck T, Donnelly JP, et al. Empiric vs Preemptive Antifungal Strategy in High-Risk Neutropenic Patients on Fluconazole Prophylaxis: A Randomized Trial of the European Organization for Research and Treatment of Cancer. Clin Infect Dis. 2023;76(4):674-682. doi:10.1093/cid/ciac623 19. Aguilar-Guisado M, Espigado I, Martín-Peña A, et al. Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 trial. Lancet Haematol. 2017;4(12):e573-e583. doi:10.1016/S2352-3026(17)30211-9