Infections in Cancer Patients with Solid Tumors: A Review.
Infections in Cancer Patients with Solid Tumors: A Review.
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DOI：
10.1007/s40121-017-0146-1
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发表时间：
2017-03
影响因子：
5.4
通讯作者：
Rolston KV
中科院分区：
文献类型：
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作者：
Rolston KV
实体瘤比血液系统恶性肿瘤更常见。虽然严重和长期的中性粒细胞减少症并不常见，但有几个因素会增加实体瘤患者的感染风险，并且同一患者中存在多种风险因素并不罕见。这些因素包括阻塞（最常见的是由肿瘤进展引起的）、自然解剖屏障（如皮肤和粘膜表面）的破坏、治疗相关因素（如化疗、放疗、诊断和/或治疗性外科手术）以及医疗器械（如各种导管、支架和假体）的使用增加。常见的感染部位包括皮肤和皮肤结构（包括手术部位感染）、血流（包括与中心静脉导管相关的感染）、肺、肝胆道和肠道以及泌尿道，并且包括不同的临床综合征，如梗阻后肺炎、梗阻性尿路病和贫血性小肠结肠炎。大多数这些感染的流行病学正在发生变化，耐药微生物[MRSA、铜绿假单胞菌、产超广谱β-内酰胺酶（ESBL）微生物]比过去更常被分离出来。当涉及深部组织部位时，多微生物感染现在占主导地位。大多数这些感染的保守治疗（抗生素，液体和电解质替代，必要时肠道休息）通常是有效的，手术干预被保留用于深部脓肿的引流，或处理并发症，如肠梗阻或出血。感染的假体通常需要移除。某些病毒感染（HBV，HCV，偶尔CMV）的重新激活已成为一个重要问题，筛查，预防和治疗策略正在开发中。感染预防、感染控制和抗菌药物管理是实体瘤患者感染总体管理的重要策略。偶尔，感染模仿实体瘤，并导致诊断和治疗的挑战。
Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses. Common sites of infection include the skin and skin structures (including surgical site infections), the bloodstream (including infections associated with central venous catheters), the lungs, the hepato-biliary and intestinal tracts, and the urinary tract, and include distinct clinical syndromes such as post-obstructive pneumonia, obstructive uropathy, and neutropenic enterocolitis. The epidemiology of most of these infections is changing with resistant organisms [MRSA, Pseudomonas aeruginosa, extended spectrum beta-lactamase (ESBL)-producing organisms] being isolated more often than in the past. Polymicrobial infections now predominate when deep tissue sites are involved. Conservative management of most of these infections (antibiotics, fluid and electrolyte replacement, bowel rest when needed) is generally effective, with surgical intervention being reserved for the drainage of deep abscesses, or to deal with complications such as intestinal obstruction or hemorrhage. Infected prostheses often need to be removed. Reactivation of certain viral infections (HBV, HCV, and occasionally CMV) has become an important issue, and screening, prevention and treatment strategies are being developed. Infection prevention, infection control, and antimicrobial stewardship are important strategies in the overall management of infections in patients with solid tumors. Occasionally, infections mimic solid tumors and cause diagnostic and therapeutic challenges.