A 49-year-old woman who has metastatic breast cancer is evaluated in the emergency department for shortness of breath, fever, and chills. She is undergoing chemotherapy through a tunneled central venous catheter; her last cycle was five days ago. Blood cultures are drawn and she is started empirically on cefepime. Vital signs are: temperature 39.4°C (102.9°F); heart rate 121 beats/min, blood pressure 78/42 mmHg, and respiratory rate 30 breaths/min. Chest radiography reveals pulmonary infiltrates. White blood cell count is 600/μL, bands 55%, segmented cells 10%. On further examination, it is noted that the area around her intravascular catheter site demonstrates redness and some swelling.
Which of the following is the most appropriate change to her antimicrobial regimen?
A. Switch cefepime to linezolid.
B. Switch cefepime to piperacillin/tazobactam.
C. Add vancomycin.
D. Add oxacillin.
E. Switch cefepime to ceftriaxone and azithromycin.
答案解析：
不建议将万古霉素（或对需氧革兰氏阳性球菌有活性的任何其他药物）作为发热和中性粒细胞减少症初始抗生素治疗方案的标准部分。这些药物应考虑用于特定的临床适应症，包括疑似导管相关感染、皮肤或软组织感染、肺炎或血流动力学不稳定。
需要添加抗耐甲氧西林金黄色葡萄球菌的药物。发热性中性粒细胞减少患者仍需要覆盖革兰氏阴性，因此换用仅利奈唑胺是不合适的。没有理由怀疑头孢吡肟失败，因此换用哌拉西林/他唑巴坦是不必要的。苯唑西林不适合经验性覆盖潜在的多重耐药革兰氏阳性菌。未怀疑社区获得性肺炎，不推荐头孢曲松和阿奇霉素作为经验性治疗。
正确答案：C
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