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Infectious Diseases


Answer 1
  1. Add an aminoglycoside. The patient’s skin lesions are characteristic of ecthyma gangrenosum, which is classically seen with disseminated pseudomonal infection. Because Pseudomonas can be drug-resistant, it is recommended that 2 agents with antipseudomonal activity be used until results of sensitivity studies are available.1 Empiric antifungal therapy is recommended after 1 week of persistent fever in patients on broad-spectrum antibiotics;2 the case patient has had febrile neutropenia for only 3 days. Both cefepime and piperacillin-tazobactam are active against gram-negative bacilli and are appropriate agents for neutropenic fever; therefore, changing piperacillin-tazobactam to cefepime would not be beneficial.3

    REFERENCE
    1. Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduce mortality in gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 2004;4:519–27.

    2. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730–51.

    3. Bow EJ, Rotstein C, Noskin GA, et al. A randomized, open-label, multicenter comparative study of the efficacy and safety of piperacillin-tazobactam and cefepime for the empirical treatment of febrile neutropenic episodes in patients with hematologic malignancies. Clin Infect Dis 2006;43:227–459

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