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Update on the epidemiology of infections in cancer patients

Abstract number: 1732_50

Maschmeyer G.

Infections are among the most frequent complications occurring in cancer patients undergoing antineoplastic chemo- or immunotherapy. Invasive fungal infections today represent the main causes of fatal outcome. Early diagnosis of probable or proven invasive aspergillosis is therefore one of the most important objectives of supportive care in patients with profound and prolonged neutropenia. With the advent of more effective and well-tolerated antifungals active against aspergillosis, the incidence of other mould infections such as zygomycosis is on the rise.

The use of highly aggressive chemotherapy induces severe mucosal damage in many cancer patients. Apart from neutropaenic enterocolitis, a broad spectrum of infections associated with impairment of mucosal barriers may be clinically important, e.g., streptococcal bacteraemia, septic enterococcal infection, or candidaemia. The widely spread use of multi-lumen central venous catheters causes a considerable number of bloodstream infections caused by coagulase-negative staphylococci, S. aureus, Gram-negative bacilli, or Candida spp. Primary removal of foreign material may be important for the successful management of these catheter-related infections.

Allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning has become more common also for treatment of aggressive haematologic malignancies in elderly patients as well as in patients with severe co-morbidity, who formerly have not been taken into consideration for myeloablative transplant procedures. Despite a marked reduction of complications related to pancytopenia combined with acute graft-versus-host reaction, the rate of severe and life-threatening fungal infections and cytomegalovirus diseases has turned out to be comparable to conventional allogeneic transplantation. Most importantly, more than half of these infectious complications emerge after more than 90 days post transplant, i.e., in patients already managed on an outpatient basis.

The broad introduction of monoclonal antibodies to CD20 and CD52 and of nucleoside analogs into the treatment of patients with B- or T-cell lymphomas has lead to long-term depletion of B cells, eventually associated with decreasing levels of serum immunoglobulins, and T-cell deficiency lasting for many years. Particularly in patients being treated with these compounds for relapsed or refractory malignancy, a high number of infections caused by pathogenic viruses such as CMV, invasive fungi or Pneumocystis jiroveci are observed. Targeted prophylaxis is warranted for selected patient groups, whereas high alertness and early pre-emptive antimicrobial intervention is mandatory in the majority of these patients.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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