12
Treatment
Persistent or Recurrent Episodes
Î Yeasts and molds remain the primary cause of infection-associated
fever and neutropenia. Therefore, empiric antifungal therapy (Table 5)
should be added to the antibacterial regimen (SR-H).
• Empiric administration of vancomycin or other agents with Gram-positive activity
(linezolid, daptomycin or ceftaroline) should be added if not already being
administered (SR-H)
• Candida spp. SSTIs should be treated with an echinocandin or, if C. parapsilosis
has been isolated, lipid formulation amphotericin-B (SR-H) with fluconazole as an
acceptable alternative (SR-M). Treatment should be for 2 weeks after clearance of
blood stream infection or resolution of skin lesions (SR-M).
• Aspergillus SSTIs should be treated with voriconazole (SR-H) or, alternatively,
lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12
weeks (SR-L). Mucor/Rhizopus infections should be treated with lipid formulation
amphotericin B (SR-M) or posaconazole (SR-L) (Table 5). The addition of
an echinocandin could be considered based on synerg y in murine models of
mucormycosis and observational clinical data (WR-L).
• Fusarium spp. infections should be treated with high-dose IV voriconazole or
posaconazole (SR-L).
• Begin treatment for antibiotic-resistant bacterial organisms (Table 6) in patients
currently on antibiotics (SR-M).
• Intravenous acyclovir should be added to the patient's antimicrobial regimen
for suspected or confirmed cutaneous or disseminated HSV or VZV infections
(SR-M).
Î Blood cultures should be obtained, and skin lesions in this population
of patients should be aggressively evaluated by culture aspiration,
biopsy or surgical excision since they may be caused by resistant
microbes, yeast or molds (SR-M).
Î The sensitivity of a single serum fungal antigen test (1-3 β-D-glucan
or galactomannan tests] is low particularly in patients receiving
antifungal agents, and benefits from laboratory tests for fungal
antigen or DNA detection remain inconsistent (SR-M).
Î Polymerase chain reaction (PCR) in peripheral blood for HSV and VZV
might be helpful in establishing a diagnosis of disseminated infection
in patients with unexplained skin lesions (WR-M).
