Infektionsprävention bei hämatologisch-onkologischen Patienten in der Pädiatrie. Problemstellung

Zusammenfassung.

Die Beherrschung infektiöser Komplikationen durch eine medikamentöse Prophylaxe, frühzeitige Diagnostik und adäquate antimikrobielle Therapie hat neben einer intensivierten zytostatischen Therapie die Heilungschancen der meisten kindlichen Malignome über die letzten 20 Jahre verbessert. Dieser Artikel gibt einen Überblick über die Bedeutung der Infektionsprävention bei pädiatrischen hämatologisch-onkologischen Patienten, die Besonderheiten dieser Patientengruppe bei der Infektionsentstehung und -ausbreitung sowie das Spektrum der Erreger von Infektionen und die Möglichkeiten prophylaktischer Maßnahmen.

The control of severe infectious complications by preventive strategies, early diagnosis of infections and empiric broad-spectrum antibiotic therapy contributed to a marked improvement of survival in children with cancer over the last 20 years. This article overviews of the importance of prevention of infectious complications in immunocompromised pediatric patients with hematologic or oncologic diseases. The particular challenge of this age group with respect to the acquisition and the spread of pathogens, the spectrum of causative microorganisms and the principal issues of anti-infectious prophylaxis are considered.

Schlüsselwörter

Infektionsprävention - hämatologisch-onkologischer Patient - Immunsuppression - Kindesalter - medikamentöse Prophylaxe - nicht-medikamentöse Prophylaxe

Key words

Prevention of infections - cancer - childhood - neutropenia

Literatur

• 01 Blaho  K, Winbery  S, Merigian  K. Pharmacological considerations for the pediatric patient.  Optom Clin. 1996;  5 61-90
• 02 Bodey  G P, Buckley  M, Sathe  Y S, Freireich  E J. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia.  Ann Intern Med. 1966;  64 328-340
• 03 Busca  A, Saroglia  E M, Giacchino  M, Vai  S, Vassallo  E, Fagioli  F, Linari  A, Dotti  G, Miniero  R, Madon  E. Analysis of early infectious complications in pediatric patients undergoing bone marrow transplantation.  Support Care Cancer. 1999;  7 253-259
• 04 Einsele  H, Hebart  H, Kanz  L. Virusinfektionen bei Patienten mit Tumorerkrankungen.  Onkologe. 1997;  Suppl 1 S55-S61
• 05 Groeger  J S, Lucas  A B, Thaler  H T, Friedlander-Klar  H, Brown  A E, Keihn  T E, Armstrong  D. Infectious morbidity associated with long-term use of venous access devices in patients with cancer.  Ann Intern Med. 1993;  119 1168-1174
• 06 Gunter  G, Garlund  B, Hast  R, Kimby  E, Nordin  M, Wretlind  B. Endotoxaemia and inflammatory mediators in febrile patients with haematological disease.  J Intern Med. 1995;  237 27-33
• 07 Hann  I, Viscoli  C, Paesmans  M, Gaya  H, Glauser  M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC).  Br J Haematol. 1997;  99 580-588
• 08 Kim  D S, Park  M S. Antibiotic use at a pediatric age.  Yonsei Med J. 1998;  39 595-603
• 09 Kock  H J, Pietsch  M, Krause  U, Wilke  H, Eigler  F W. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems.  World J Surg. 1998;  22 12-16
• 10 Kumar  A, Brar  S S, Murray  D L, Leader  I, Gera  R, Kulkarni  R. Central venous catheter infections in pediatric patients in a community hospital.  Infection. 1988;  16 86-90
• 11 Lehrnbecher  T, Foster  C, Vazquez  N, Mackall  C L, Chanock  S J. Therapy-induced alterations in host defense in children receiving therapy for cancer.  J Pediatr Hematol Oncol. 1997;  19 399-417
• 12 Pizzo  P A. Considerations for prevention of infectious complications in patients with cancer.  Rev Infect Dis. 1989;  11 S1551-S1563
• 13 Pizzo  P A. Managment of fever in patients with cancer and treatment-induced neutropenia.  New Engl J Med. 1993;  328 1323-1332
• 14 Risi  G F, Tomascak  V. Prevention of infection in the immunocompromised host.  Am J Infect Control. 1998;  26 594-604
• 15 Schimpff  S C, Young  V M, Greene  W H, Vermeulen  G D, Moody  M R, Wiernick  P H. Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens.  Ann Intern Med. 1972;  77 707-714