This article, prepared by the Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guidelines Panel, updates guidelines established a decade ago by the Infectious Disease Society of America for the use of antimicrobial agents to treat neutropenic patients with unexplained fever [1]. DefinitionsFever is defined as a single oral temperature of у38.3ЊC (101ЊF) or a temperature of у38.0ЊC (100.4ЊF) for у1 h. Neutropenia is defined as a neutrophil count of !500 cells/mm 3 , or a count of !1000 cells/mm 3 with a predicted decrease to !500 cells/mm 3 . Initial EvaluationDetermine whether the patient is at low risk for complications; determine whether vancomycin therapy is needed. Initial Antibiotic TherapyOral route. For low-risk adults only; use ciprofloxacin plus amoxicillin-clavulanate.Monotherapy with vancomycin not indicated.

This is the first in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are internists, pediatricians, and family practitioners. The targeted patients and setting for the fever and neutropenia guideline are hospitalized individuals with neutropenia secondary to cancer chemotherapy. Panel members represented experts in adult and pediatric infectious diseases and oncology. The guidelines are evidence-based. A standard ranking system was used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary, algorithms, and tables highlight the major recommendations. The guideline will be listed on the IDSA home page at http://www.idsociety.org.

More than 100 cases of Rhodococcus equi infection have been reported since the first description of human disease caused by this organism. The vast majority of patients infected with R. equi are immunocompromised, and two-thirds have human immunodeficiency virus infection. The clinical manifestations of R. equi infection are diverse, although 80% of patients have some pulmonary involvement. The organism is easily cultured from specimens of infected tissue or body fluid, but it may be misdiagnosed as a contaminant. Treatment is often prolonged, and relapses at distant sites are common. This article summarizes the history, diagnosis, clinical features, and treatment of infection with this emerging pathogen.

Disseminated infection with Mycobacterium avium complex developed in 67 patients with the acquired immunodeficiency syndrome (AIDS) who were followed at Memorial Sloan-Kettering Cancer Center. Twenty-nine patients were treated with two or more antimycobacterial drugs for a mean of 6 weeks, and 7 patients received therapy for less than 1 month. Most patients received ansamycin, clofazimine, and ethionamide or ethambutol. Clinical improvement did not occur in treated patients, and microbiologic cure was never obtained. Mycobacterial bacteremia persisted in 24 of 26 treated patients. Colony counts of M. avium complex in sequential blood cultures decreased in 3 patients. Every autopsied patient with M. avium complex infection diagnosed before death, whether treated or not, had disseminated M. avium complex infection at autopsy.