Kanser hastalarında infeksiyon

Kanser hastaları, gerek hastalığın kendisi gerekse uygulanan kemoterapiler nedeniyle, özellikle de nötropeni gelişmiş ise, bakteriyel ve fungal infeksiyonlara duyarlılığı artmış hastalardır. Ayrıca kanserli hastalarda gelişen infeksiyonlar yüksek morbidite ve mortalite ile seyretmektedir. Ancak, özellikle febril nötropeni (FN) tanımını izleyen süreçte önemli gelişmeler olmuştur. FN hastaları ile ilişkili tanı ve tedavi algoritmaları oluşturulmuş ve hastalarda infeksiyon ilişkili mortalite % 10’ların altına indirilmiştir. Gerek FN tanımlanan kanser hastaları, gerekse nötropeni olmaksızın infeksiyon duyarlılığı artmış kanser hastaları heterojen bir gruptur. Bu nedenle standart tanı ve tedavi yaklaşımları, hastanın bireysel özelliklerinin doğru ve ayrıntılı analizi, kurumsal farklılıklar ve yeni tedavi yaklaşımları ile ilişkili yeni immunsupresyon türleri ile birlikte hem bütüncül hem de hasta özelinde bireysel bir yaklaşımla ele alınmalıdır.

Infections in cancer patients

Cancer patients, became compromised either due to underlying illness or as a result of chemotherapy, are highly susceptible, especially if they are neutropenic, to any kind of bacterial and fungal infections. Also, these infections are associated with significant morbidity and mortality. However, due to significant improvements after the first definition of febrile neutropenia (FN) the mortality rates associated with infection could have been reduced under the rates of 10 %. As the cancer patients including the febrile neutropenic patients are not homogenous, we still have to consider that every cancer patients with infection deserves special attention. The algorithms produced by experts and societies in this field should be combined both with the local institutional patterns and the pattern of the immunsupression due to new chemotherapy regimens.

PDF

___

1. Antoniadou A, Giamarellou H: Fever of unknown origin in febrile leukopenia, Infect Dis Clin North Am 2007;21(4):1055-90.
2. Bodey GP: Infection in cancer patients, Am J Med 1988;81(Suppl 1A):11-26.
3. Emmanoulides C, Glaspy J: Opportunistic infections in oncologic patients, Hematol/Oncol Clin North Am 1996;10(4):841-61.
4. Giamarellou H: Empiric therapy for infections in the febrile neutropenic compromised host, Med Clin North Am 1995;79(3):559-80.
5. Hughes WT, Armstrong D, Bodey GP et al: 2002 guidelines for the use of antimicrobial agents in neutropenc patients with unexplained fever, Clin Infect Dis 2002;34(6):730-51.
6. Klastersky J, Paesmans M, Rubinstein EB et al: The Multinational Association for Supportive Care in Cancer Risk index: A multinational scoring system for identify low-risk febrile neutropenic cancer patients, J Clin Oncol 2000;18(16):3038-51.
7. Pizzo PA: Management of fever in patients with cancer and treatment induced neutropenia, N Engl J Med 1993;328(18):1323-32.
8. Pizzo PA: Granulocytopenia and cancer chemo- therapy. Past problems, current solutions, future challenges, Cancer 1984;54(11 Suppl):2649-61.
9. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG: Empiric antibiotic and antifungal therapy for can- cer patients with prolonged fever and granulocy- topenia, Am J Med 1982;72(1):101-11.
10. Rolston KV: New trends in patient management: risk-based therapy for febrile patients with neut- ropenia, Clin Infect Dis 1999;29(3):515-21.
11. Sandin RI, Rinaldi M: Special considerations for the clinical microbiology laboratory in the diagno- sis of infections in the cancer patient, Infect Dis Clin North Am 1996;10(2):413-30.
12. Sipsas NV, Bodey GP, Kontoyiannis DP: Perspectives for the management of febrile neutropenic patients with cancer in 21st century, Cancer 2005;103(6):1103-13.
13. Viscoli C: The evolution of the empirical manage- ment of fever and neutropenia in cancer patients, J Antimicrob Chemother 1998;41(Suppl D):65-80.
14. Young SD, Feld R: Fever associated with chemotherapy-induced neutropenia: a review of current therapeutic approaches, Curr Opin Infect Dis 1998;11(4):401-9.