The Lancet Regional Health. Europe (Apr 2025)
2024 update of the AGIHO guideline on diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients with solid tumours and hematological malignancies
- Michael Sandherr,
- Jannik Stemler,
- Enrico Schalk,
- Tessa Hattenhauer,
- Marcus Hentrich,
- Bernd Hertenstein,
- Christian Hohmann,
- Sibylle C. Mellinghoff,
- Rebekka Mispelbaum,
- Christina Rieger,
- Martin Schmidt-Hieber,
- Rosanne Sprute,
- Guenter Weiss,
- Oliver A. Cornely,
- Larissa Henze,
- Cornelia Lass-Floerl,
- Gernot Beutel,
- Annika Y. Classen,
- Noemi F. Freise,
- Meinolf Karthaus,
- Philipp Koehler,
- Robert Krause,
- Julia Neuhann,
- Hans Martin Orth,
- Olaf Penack,
- Markus Schaich,
- Karsten Spiekermann,
- Sebastian Voigt,
- Florian Weissinger,
- Elena Busch
Affiliations
- Michael Sandherr
- Specialist Clinic for Hematology and Oncology, Medical Care Center Penzberg, Germany; Corresponding author.
- Jannik Stemler
- University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Cologne, Germany
- Enrico Schalk
- Department of Hematology, Oncology and Cell Therapy, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Tessa Hattenhauer
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
- Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
- Bernd Hertenstein
- Department of Medicine, Clinic I - Hematology, Oncology, Infectiology, Department of Intensive Care and Emergency Medicine, Klinikum Bremen-Mitte, Bremen, Germany
- Christian Hohmann
- Department of Medicine, Clinic I - Hematology, Oncology, Infectiology, Department of Intensive Care and Emergency Medicine, Klinikum Bremen-Mitte, Bremen, Germany
- Sibylle C. Mellinghoff
- University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Cologne, Germany
- Rebekka Mispelbaum
- Department of Oncology, Hematology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
- Christina Rieger
- Department of Hematology and Oncology Germering, Germering, Germany
- Martin Schmidt-Hieber
- Clinic for Oncology, Hematology, Pneumology, Nephrology and Diabetology, Carl-Thiem Clinic, Cottbus, Germany
- Rosanne Sprute
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- Guenter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
- Oliver A. Cornely
- University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Cologne, Germany
- Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany; Department of Internal Medicine II, Hematology, Oncology and Palliative Medicine, Asklepios Hospital Harz, Goslar, Germany
- Cornelia Lass-Floerl
- Institut of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
- Gernot Beutel
- Department of Internal Medicine, Hematology, Oncology and Stem Cell Transplantation, Medical University of Hannover, Hannover, Germany
- Annika Y. Classen
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Noemi F. Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
- Meinolf Karthaus
- Department Hematology, Oncology and Palliative Care, Klinikum Neuperlach and Harlaching, Munich, Germany
- Philipp Koehler
- University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Austria; BioTechMed, Graz, Austria
- Julia Neuhann
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany
- Olaf Penack
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
- Markus Schaich
- Department of Hematology, Oncology and Palliative Care, Rems-Murr-Klinikum Winnenden, Germany
- Karsten Spiekermann
- Department of Medicine III, LMU University Hospital, LMU Munich, Germany
- Sebastian Voigt
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Florian Weissinger
- Evangelic Hospital Bethel, Bielefeld, Germany
- Elena Busch
- Internal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
- Journal volume & issue
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Vol. 51
p. 101214
Abstract
Summary: Febrile Neutropenia is an emergency in the treatment of cancer patients. It requires prompt and evidence-based clinical and antimicrobial management. The implementation of standard operating procedures (SOP) across hospitals and outpatient cancer departments can improve the outcome of FN patients by reducing FN-related morbidity and mortality and by the continuation of cancer treatment. This guideline describes an evidence-based approach to risk stratification, epidemiology, diagnosis, and treatment. It is provided by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and is an update of the 2017 version. Emerging aspects in epidemiology, diagnostic procedures, risk stratification, first-line antimicrobial treatment, empiric antifungal treatment and the duration of antimicrobial treatment are discussed and rated on evidence-based strength of recommendation and quality of evidence as described by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). By this, the aim of this guideline is to provide evidence-based recommendations on the management of febrile neutropenia in cancer patients for the practicing clinician.
