Infektionen bei Kindern mit Krebserkrankungen

Zusammenfassung

Trotz aller Fortschritte in der Supportivtherapie gehören Infektionen immer noch zu häufigen und potenziell lebensbedrohlichen Komplikationen bei krebskranken Kindern. Die Granulozytopenie ist der wichtigste Einzelrisikofaktor für Infektionen, jedoch macht die komplexe Störung aller Arme des Immunsystems die Kinder für eine Vielzahl von opportunistischen Keimen empfänglich. Heutzutage werden bei krebskranken Kindern überwiegend Gram-positive Erreger isoliert; Gram-negative Erreger können binnen kürzester Zeit zu schwersten septischen Krankheitsbildern führen. Bei prolongierter Granulozytopenie steigt zudem das Risiko für eine Pilzinfektion. Während Fieber oft das einzige Zeichen einer Infektion ist, fehlen gerade in der Frühphase der Infektion meist spezifische klinische oder radiologische Zeichen. Da auch keine Laborparameter frühzeitig und verlässlich eine Infektion anzeigen, erhalten heute alle Kinder mit Fieber bei Granulozytopenie eine empirische antibiotische Therapie. Eine Stratifizierung durch klinische, laborchemische oder genetische Risikofaktoren wird derzeit evaluiert, kann aber noch nicht allgemein empfohlen werden.

Summary

Infectious complications are still a major cause of morbidity and mortality in children undergoing therapy for an underlying malignancy. The most important risk factor for infectious risk in pediatric patients with cancer is therapy-induced neutropenia. Compared to gram-positive pathogens, gram-negative organisms are isolated less frequently, but are associated with considerably higher mortality rates. Prolonged neutropenia increases the risk for invasive fungal infection. In most cases, fever is an important and early indication of serious infection. Discrimination between serious and inconsequential infection in febrile children with neutropenia at the time of presentation is difficult, and serum markers have not been proven to reliably indicate infection. Although several groups investigate risk categories based on clinical tests or the genetic background, the current paradigm is to treat all pediatric patients with neutropenia and fever with intravenous broad-spectrum antibiotics. It is hoped that the identification of one or more predictive factors may be useful for tailoring antibiotic therapy in children with cancer.

Schlüsselwörter

Krebserkrankungen - Infektionen

Keywords

Cancer - infectious complication

• Literatur

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