Antimicrobial therapy of febrile complications after high-dose chemo-/radiotherapy and autologous hematopoietic stem cell transplantation -: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)
Antimicrobial therapy of febrile complications after high-dose chemo-/radiotherapy and autologous hematopoietic stem cell transplantation -: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)
复制标题
DOI：
10.1007/s00277-003-0771-5
复制
发表时间：
2003-10-01
影响因子：
3.5
通讯作者：
Maschmeyer, G
中科院分区：
文献类型：
--
作者：
Bertz, H;Auner, HW;Maschmeyer, G
高剂量化疗（HDC）和自体造血干细胞移植（HSCT）后患者的感染性并发症发生率为60-100%，通常由革兰氏阴性需氧菌（如铜绿假单胞菌和肠杆菌科）和革兰氏阳性球菌（如肠球菌、链球菌和葡萄球菌）引起，应纳入经经验一线抗生素治疗。较不常见的感染是由真菌和厌氧菌引起的，初始治疗不一定要涵盖凝固酶阴性葡萄球菌、耐氧西林金黄色葡萄球菌（MRSA）、厌氧菌和真菌。已经接受抗生素治疗并出现肺部浸润的患者应立即接受全身抗真菌药物治疗。发热、腹泻或其他胃肠道或肛周感染体征和症状的患者应使用抗生素治疗，包括厌氧菌和肠球菌。临床稳定的皮肤感染或中心静脉导管相关感染患者可以使用标准的经验性抗生素治疗，包括抗铜绿假单胞菌的β -内酰胺（含或不含氨基糖苷），只有在一线治疗72小时内无反应、临床不稳定、有严重粘膜炎或对经验性抗生素有耐药性时才应使用糖肽。重组造血生长因子不应常规添加，但可考虑在危及生命的情况下，如侵袭性肺真菌病或败血症。
Infectious complications occur in 60-100% of patients following high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (HSCT), and are commonly caused by Gram-negative aerobic bacteria (such as Pseudomonas aeruginosa and enterobacteriaceae) and Gram-positive cocci (such as enterococci, streptococci and staphylococci), which should be covered by empiric first-line antibiotic therapy. Less frequently, infections are caused by fungi and anaerobic bacteria, and initial therapy does not necessarily have to cover coagulase-negative staphylococci, oxacillin-resistant S. aureus (MRSA), anaerobic bacteria and fungi. Patients who already receive antibiotics and develop pulmonary infiltrates should immediately be treated with systemic antifungals. Patients with fever and diarrhea or other signs and symptoms of gastrointestinal or perianal infection should be treated with antibiotics covering anaerobic bacteria and enterococci. Clinically stable patients with skin infections or central venous catheter-related infections can be treated with standard empiric antibiotic therapy including a beta-lactam active against Pseudomonas aeruginosa with or without an aminoglycoside, and should only receive glycopeptides if they do not respond to first-line therapy within 72 hours, become clinically unstable, have severe mucositis, or when resistance against the empiric antibiotics is demonstrated. Recombinant hematopoietic growth factors should not be added routinely but may be considered in life-threatening situations such as invasive pulmonary mycoses or sepsis.