The epidemiology and treatment of infections in cancer patients
The epidemiology and treatment of infections in cancer patients
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DOI：
10.1016/j.ijantimicag.2007.06.014
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发表时间：
2008-03-01
影响因子：
10.8
通讯作者：
Haas, Antje
中科院分区：
文献类型：
--
作者：
Maschmeyer, Georg;Haas, Antje
在过去的十年中，癌症患者感染性并发症的流行病学发生了重大变化。在发热性血小板减少症患者的血培养分离株中，革兰氏阳性病原体已成为主要病原体，并且必须考虑耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌的传播增加。风险因素，如留置静脉导管或化疗引起的粘膜损伤与革兰氏阳性菌感染的发病率增加有关。侵袭性真菌感染，特别是侵袭性曲霉菌病，已成为严重贫血患者中最重要的，并与40- 60%的死亡率相关。使用核苷类似物和CD 52-抗体Alemtuzumab可诱导持久的淋巴细胞减少症，促进病毒和真菌特异性引起的机会性感染的发生。在接受强化骨髓抑制化疗的老年患者中，通过适当的抗菌治疗，感染并发症可以像年轻患者一样成功管理。氟喹诺酮类抗生素预防性应用于血小板减少症患者可能导致革兰阴性杆菌如大肠埃希菌的高耐药率。杆菌在接受阿托沙星预防感染的患者中，报告了不可接受的大量艰难梭菌相关性小肠结肠炎。(C)2007年爱思唯尔B。和国际化疗学会。All rights reserved.
Significant changes in the epidemiology of infectious complications in cancer patients have emerged during the past decade. Among blood culture isolates from febrile neutropenic patients, Gram-positive pathogens have become predominant, and an increasing spread of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci must be taken into consideration. Risk factors such as indwelling venous catheters or chemotherapy-induced mucosal damage are associated with an increased incidence of Gram-positive infections. Invasive fungal infections, particularly invasive aspergillosis, have become most important in severely neutropenic patients and are associated with fatality rates of 40-60%. The use of nucleoside analogues and the CD52-antibody alemtuzumab induce a long-lasting lymphopenia facilitating the occurrence of opportunistic infections specifically caused by viruses and fungi. In elderly patients undergoing intensive myelosuppressive chemotherapy, infectious complications may be managed as successfully as in younger patients by appropriate antimicrobial therapy. The broad use of fluoroquinolones for antibacterial prophylaxis in neutropenic patients may lead to very high resistance rates among Gram-negative bacilli such as E. coli. In patients given moxifloxacin for infection prevention, unacceptably large numbers of Clostridium difficile-associated enterocolitis have been reported. (C) 2007 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.