中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2020年版)

2020-12-30 中华医学会血液学分会 中华血液学杂志.2020.41(12):969-978.

中性粒细胞缺乏(粒缺)伴发热患者是一组特殊的疾病人群。由于免疫功能低下,炎症相关临床症状和体征常不明显,病原菌及感染灶也不明确,发热可能是感染的唯一征象,如未及时给予恰当的抗菌药物治疗,感染相关死亡率

中文标题:

中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2020年版)

发布日期:

2020-12-30

简要介绍:

中性粒细胞缺乏(粒缺)伴发热患者是一组特殊的疾病人群。由于免疫功能低下,炎症相关临床症状和体征常不明显,病原菌及感染灶也不明确,发热可能是感染的唯一征象,如未及时给予恰当的抗菌药物治疗,感染相关死亡率高。因此,充分认识粒缺伴发热患者的相关风险、诊断方法以及如何合理使用抗菌药物,对于降低粒缺伴发热的发生率和死亡风险至关重要。

《中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2016 年版)》发表至今4 年,对临床诊疗发挥了很好的指导作用。期间国际及国内关于粒缺伴发热的诊疗理念发生了一些重要变化,我国在粒缺伴发热的病原学,尤其是耐药菌监测方面也积累了大量临床研究和流行病学数据,新型靶向药物及免疫治疗的应用带来新的危险因素。因此,参考欧洲白血病感染相关指南(ECIL 指南)、美国感染病学会(IDSA)肿瘤合并粒缺患者治疗指南(IDSA指南)、2019 年西班牙血液恶性肿瘤患者粒缺伴发热管理共识等,结合我国当前细菌流行病学、耐药菌监测数据及抗菌药物临床应用经验总结,中华医学会血液学分会和中国医师协会血液科医师分会对2016年版指南进行修订。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1084055, encodeId=09291084055ae, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Fri Dec 24 21:48:00 CST 2021, time=2021-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075626, encodeId=7ade10e56261a, content=很好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=629d6157414, createdName=ms6000001269907517, createdTime=Tue Nov 30 23:40:15 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074775, encodeId=d0ab10e4775e1, content=值得学习, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0f15401741, createdName=ms8000001525858897, createdTime=Sun Nov 28 15:39:20 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068313, encodeId=495f1068313c3, content=好用好用, beContent=null, objectType=guider, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epicMDGlXJOrp6ibNVqDTEJrXn33xF2dYIXib6eZxsIE3L8dRYicWFp2DOAXhHVLpwBxFV19ufrqXYNOQ/132, createdBy=156b2545676, createdName=lnyxzl, createdTime=Mon Nov 08 22:55:20 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064677, encodeId=c69810646e7bb, content=好好好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=514d5556399, createdName=谷芬, createdTime=Thu Oct 28 14:59:33 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-12-24 坚定的心

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1084055, encodeId=09291084055ae, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Fri Dec 24 21:48:00 CST 2021, time=2021-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075626, encodeId=7ade10e56261a, content=很好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=629d6157414, createdName=ms6000001269907517, createdTime=Tue Nov 30 23:40:15 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074775, encodeId=d0ab10e4775e1, content=值得学习, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0f15401741, createdName=ms8000001525858897, createdTime=Sun Nov 28 15:39:20 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068313, encodeId=495f1068313c3, content=好用好用, beContent=null, objectType=guider, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epicMDGlXJOrp6ibNVqDTEJrXn33xF2dYIXib6eZxsIE3L8dRYicWFp2DOAXhHVLpwBxFV19ufrqXYNOQ/132, createdBy=156b2545676, createdName=lnyxzl, createdTime=Mon Nov 08 22:55:20 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064677, encodeId=c69810646e7bb, content=好好好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=514d5556399, createdName=谷芬, createdTime=Thu Oct 28 14:59:33 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-11-30 ms6000001269907517

    很好

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1084055, encodeId=09291084055ae, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Fri Dec 24 21:48:00 CST 2021, time=2021-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075626, encodeId=7ade10e56261a, content=很好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=629d6157414, createdName=ms6000001269907517, createdTime=Tue Nov 30 23:40:15 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074775, encodeId=d0ab10e4775e1, content=值得学习, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0f15401741, createdName=ms8000001525858897, createdTime=Sun Nov 28 15:39:20 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068313, encodeId=495f1068313c3, content=好用好用, beContent=null, objectType=guider, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epicMDGlXJOrp6ibNVqDTEJrXn33xF2dYIXib6eZxsIE3L8dRYicWFp2DOAXhHVLpwBxFV19ufrqXYNOQ/132, createdBy=156b2545676, createdName=lnyxzl, createdTime=Mon Nov 08 22:55:20 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064677, encodeId=c69810646e7bb, content=好好好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=514d5556399, createdName=谷芬, createdTime=Thu Oct 28 14:59:33 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-11-28 ms8000001525858897

    值得学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1084055, encodeId=09291084055ae, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Fri Dec 24 21:48:00 CST 2021, time=2021-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075626, encodeId=7ade10e56261a, content=很好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=629d6157414, createdName=ms6000001269907517, createdTime=Tue Nov 30 23:40:15 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074775, encodeId=d0ab10e4775e1, content=值得学习, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0f15401741, createdName=ms8000001525858897, createdTime=Sun Nov 28 15:39:20 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068313, encodeId=495f1068313c3, content=好用好用, beContent=null, objectType=guider, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epicMDGlXJOrp6ibNVqDTEJrXn33xF2dYIXib6eZxsIE3L8dRYicWFp2DOAXhHVLpwBxFV19ufrqXYNOQ/132, createdBy=156b2545676, createdName=lnyxzl, createdTime=Mon Nov 08 22:55:20 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064677, encodeId=c69810646e7bb, content=好好好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=514d5556399, createdName=谷芬, createdTime=Thu Oct 28 14:59:33 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-11-08 lnyxzl

    好用好用

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1084055, encodeId=09291084055ae, content=学习了, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Fri Dec 24 21:48:00 CST 2021, time=2021-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075626, encodeId=7ade10e56261a, content=很好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=629d6157414, createdName=ms6000001269907517, createdTime=Tue Nov 30 23:40:15 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074775, encodeId=d0ab10e4775e1, content=值得学习, beContent=null, objectType=guider, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0f15401741, createdName=ms8000001525858897, createdTime=Sun Nov 28 15:39:20 CST 2021, time=2021-11-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068313, encodeId=495f1068313c3, content=好用好用, beContent=null, objectType=guider, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epicMDGlXJOrp6ibNVqDTEJrXn33xF2dYIXib6eZxsIE3L8dRYicWFp2DOAXhHVLpwBxFV19ufrqXYNOQ/132, createdBy=156b2545676, createdName=lnyxzl, createdTime=Mon Nov 08 22:55:20 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064677, encodeId=c69810646e7bb, content=好好好, beContent=null, objectType=guider, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=514d5556399, createdName=谷芬, createdTime=Thu Oct 28 14:59:33 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-10-28 谷芬

    好好好

    0