Diagnosis and Assessment Low-Risk ÎAntifungal prophylaxis is recommended for patients in whom the
anticipated duration of neutropenia is < 7 days (A-III). Antiviral Prophylaxis
ÎHerpes simplex virus (HSV)-seropositive patients undergoing allogeneic HSCT or leukemia induction therapy should receive acyclovir antiviral prophylaxis (A-I).
ÎAntiviral treatment for HSV or varicella-zoster virus (VZV) is indicated only if there is clinical or laboratory evidence of active viral disease (C-III).
ÎRespiratory virus testing (including influenza, parainfluenza, adenovirus, respiratory syncytial virus [RSV], and human metapneumovirus) and chest radiography are indicated for patients with upper respiratory symptoms (eg, coryza) and/or cough (B-III).
ÎYearly influenza vaccination with inactivated vaccine is recommended for all patients being treated for cancer (A-II).
Optimal timing of vaccination is not established, but serologic responses may be best between chemotherapy cycles (more than 7 days after the last treatment) or more than 2 weeks before chemotherapy starts (B-III).
ÎInfluenza virus infection should be treated with neuraminidase inhibitors, if susceptible (A-II).
In the setting of an influenza exposure or outbreak, neutropenic patients presenting with influenza-like illness should receive treatment empirically (C-III).
ÎRoutine treatment of RSV in neutropenic patients with upper respiratory disease should
be given (B-III). Hematopoietic Growth Factors (G-CSF or GM-CSF)
ÎProphylactic use of myeloid colony-stimulating factors (CSFs; also referred to as hematopoietic growth factors) should be considered for patients in whom the anticipated risk of fever and neutropenia is 20% or greater (A-II).
ÎCSFs are not generally recommended for treatment of established fever and neutropenia (B-II).
Central Line-Associated Bloodstream Infections (CLABSI)
ÎDifferential time to positivity (DTP) > 120 minutes of simultaneously drawn qualitative blood cultures from the central venous catheter and a vein suggests a CLABSI (A-II).
6
N
OT
N
OT
