Infektionen bei hämatologisch-onkologischen Patienten auf der Intensivstation

Krebspatienten haben ein hohes Risiko, eine Infektion zu entwickeln, die eine Behandlung auf einer Intensivstation notwendig macht. Dies ist insbesondere bei hämatologischen Erkrankungen der Fall, da das Immunsystem fast immer am Krankheitsgeschehen beteiligt ist. Das Bild der Infektion kann mitunter sehr bunt sein, ist abhängig sowohl von der Primärerkrankung als auch der Krebstherapie und kann bis hin zum Vollbild einer Sepsis reichen.

Schlüsselwörter

Krebspatient - Infektion - Sepsis - Inflammation - Leukämie

• Literatur

• 1 Kochanek M, Shimabukuro-Vornhagen A, Russ K. et al. Prävalenz von Krebspatienten auf deutschen Intensivstationen. Med Klin Intensivmed Notfmed 2020; 115: 312-319 doi:10.1007/s00063-019-0594-3
• 2 Atkins S, He F. Chemotherapy and beyond. Infect Dis Clin North Am 2019; 33: 289-309 doi:10.1016/j.idc.2019.01.001
• 3 Kochanek M, Schalk E, von Bergwelt-Baildon M. et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98: 1051-1069 doi:10.1007/s00277-019-03622-0
• 4 Probst L, Schalk E, Liebregts T. et al. Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study. J Intensive Care 2019; 7: 41 doi:10.1186/s40560-019-0396-y
• 5 Rhodes A, Evans LE, Alhazzani W. et al. Surviving Sepsis Campaign: International Guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45: 486-552 doi:10.1097/CCM.0000000000002255
• 6 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801-810 doi:10.1001/jama.2016.0287
• 7 Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign bundle: 2018 Update. Crit Care Med 2018; 46: 997-1000 doi:10.1097/CCM.0000000000003119
• 8 Maschmeyer G, Carratala J, Buchheidt D. et al. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2015; 26: 21-33 doi:10.1093/annonc/mdu192
• 9 Gudiol C, Royo-Cebrecos C, Laporte J. et al. Clinical features, aetiology and outcome of bacteraemic pneumonia in neutropenic cancer patients. Respirology 2016; 21: 1411-1418 doi:10.1111/resp.12848
• 10 Sandherr M, Hentrich M, von Lilienfeld-Toal M. et al. Antiviral prophylaxis in patients with solid tumours and haematological malignancies-update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 2015; 94: 1441-1450 doi:10.1007/s00277-015-2447-3
• 11 von Lilienfeld-Toal M, Berger A, Christopeit M. et al. Community acquired respiratory virus infections in cancer patients-Guideline on diagnosis and management by the Infectious Diseases Working Party of the German Society for haematology and Medical Oncology. Eur J Cancer 2016; 67: 200-212 doi:10.1016/j.ejca.2016.08.015
• 12 Poortmans PM, Guarneri V, Cardoso MJ. Cancer and COVID-19: what do we really know?. Lancet 2020; 395: 1884-1885 doi:10.1016/s0140-6736(20)31240-x
• 13 He W, Chen L, Chen L. et al. COVID-19 in persons with haematological cancers. Leukemia 2020; 34: 1637-1645 doi:10.1038/s41375-020-0836-7
• 14 Mei H, Dong X, Wang Y. et al. Managing patients with cancer during the COVID-19 pandemic: frontline experience from Wuhan. Lancet Oncol 2020; 21: 634-636 doi:10.1016/s1470-2045(20)30238-2
• 15 Kuderer NM, Choueiri TK, Shah DP. et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet 2020; 395: 1907-1918 doi:10.1016/S0140-6736(20)31187-9
• 16 Lee LYW, Cazier JB, Starkey T. et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet 2020; 395: 1919-1926 doi:10.1016/s0140-6736(20)31173-9
• 17 Valentine JC, Morrissey CO, Tacey MA. et al. A population-based analysis of invasive fungal disease in haematology-oncology patients using data linkage of state-wide registries and administrative databases: 2005–2016. BMC Infect Dis 2019; 19: 274 doi:10.1186/s12879-019-3901-y
• 18 Taccone FS, Van den Abeele A-M, Bulpa P. et al. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. Crit Care 2015; 19: 7 doi:10.1186/s13054-014-0722-7
• 19 Azoulay E, Pickkers P, Soares M. et al. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 2017; 43: 1808-1819 doi:10.1007/s00134-017-4947-1
• 20 Gerritsen MG, Willemink MJ, Pompe E. et al. Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography. PloS One 2017; 12: e0172256 doi:10.1371/journal.pone.0172256
• 21 Wohlfarth P, Turki AT, Steinmann J. et al. Microbiologic diagnostic workup of acute respiratory failure with pulmonary infiltrates after allogeneic hematopoietic stem cell transplantation: findings in the era of molecular- and biomarker-based assays. Biol Blood Marrow Transplant 2018; 24: 1707-1714 doi:10.1016/j.bbmt.2018.03.007
• 22 Boch T, Spiess B, Cornely OA. et al. Diagnosis of invasive fungal infections in haematological patients by combined use of galactomannan, 1,3-β-D-glucan, Aspergillus PCR, multifungal DNA-microarray, and Aspergillus azole resistance PCRs in blood and bronchoalveolar lavage samples: results of a prospective multicentre study. Clin Microbiol Infect 2016; 22: 862-868 doi:10.1016/j.cmi.2016.06.021
• 23 Ruhnke M, Behre G, Buchheidt D. et al. Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO). Mycoses 2018; 61: 796-813 doi:10.1111/myc.12838
• 24 Ullmann AJ, Aguado JM, Arikan-Akdagli S. et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 (Suppl. 01) e1-e38 doi:10.1016/j.cmi.2018.01.002
• 25 Schmidt-Hieber M, Bierwirth J, Buchheidt D. et al. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2018; 97: 31-49 doi:10.1007/s00277-017-3183-7
• 26 Wilcox MH, Gerding DN, Poxton IR. et al. Bezlotoxumab for prevention of recurrent clostridium difficile infection. N Engl J Med 2017; 376: 305-317 doi:10.1056/NEJMoa1602615
• 27 Manthey CF, Dranova D, Christner M. et al. Initial therapy affects duration of diarrhoea in critically ill patients with Clostridioides difficile infection (CDI). Crit Care 2019; 23: 399 doi:10.1186/s13054-019-2648-6
• 28 Cattaneo C, Di Blasi R, Skert C. et al. Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria. Ann Hematol 2018; 97: 1717-1726 doi:10.1007/s00277-018-3341-6
• 29 La Rosée P, Horne A, Hines M. et al. Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood 2019; 133: 2465-2477 doi:10.1182/blood.2018894618
• 30 Henter JI, Horne A, Aricó M. et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48: 124-131 doi:10.1002/pbc.21039