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INFECCIONES BACTERIANAS Y MICOTICAS EN PACIENTES CON CANCER TRATADOS CON QUIMIOTERAPIA
(especial para SIIC © Derechos reservados)
Estudios futuros, con una estratificación del riesgo más refinada podrían verificar la aplicabilidad de regímenes simplificados de tratamiento para pacientes de bajo riesgo.
vento9.jpg Autor:
Sandro Vento
Columnista Experto de SIIC

Institución:
Section of Infectious Diseases, Department of Pathology, University of Verona


Artículos publicados por Sandro Vento
Coautor
Francesca Cainelli, MD,* 
Specialist in Infectious Diseases*
Recepción del artículo
1 de Agosto, 2005
Aprobación
3 de Agosto, 2005
Primera edición
13 de Abril, 2007
Segunda edición, ampliada y corregida
16 de Abril, 2007

Resumen
Los pacientes con cáncer tratados con quimioterapia, en particular si presentan neutropenia, son sensibles a una amplia variedad de infecciones bacterianas y micóticas, las cuales provocan significativa morbilidad y mortalidad. Los datos actuales indican que el uso profiláctico de antibióticos debería evitarse, ya que está asociado con riesgo de surgimiento de bacterias resistentes y porque no reduce la mortalidad. Por el contrario, la quimioprofilaxis desempeña un papel en las infecciones micóticas. Debido a que las infecciones en un huésped neutropénico pueden ser rápidamente mortales si no son tratadas, por lo general en estos pacientes se indica la administración empírica de antibióticos de espectro amplio por vía intravenosa, pero es de importancia cardinal considerar las frecuencias y los patrones de sensibilidad y resistencia locales de diversos patógenos. Una vez que el tratamiento ha sido iniciado, durante los primeros cinco días no está indicado el cambio del esquema antibiótico a menos que el estado clínico del paciente se deteriore de manera considerable. El tratamiento de las infecciones micóticas invasivas es particularmente problemático y, desafortunadamente, no tiene éxito en numerosos casos. Se requieren estudios adicionales para aclarar numerosas cuestiones aún no resueltas.

Palabras clave
Quimioterapia, infecciones bacterianas, infecciones micóticas, neutropenia, cáncer


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Especialidades
Principal: HematologíaOncología
  Relacionadas: BioquímicaDiagnóstico por LaboratorioFarmacologíaMedicina FarmacéuticaInfectologíaInmunologíaMedicina Interna


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BACTERIAL AND FUNGAL INFECTIONS IN PATIENTS WITH CANCER TREATED WITH CHEMOTHERAPY

Abstract
Chemotherapy-treated patients with cancer, particularly if neutropenic, are susceptible to a wide variety of bacterial and fungal infections, which cause significant morbidity and mortality. Present evidence indicates that prophylactic use of antibiotics should be avoided, as it is associated with risk of emergence of resistant bacteria and does not reduce mortality. In contrast, chemoprophylaxis has a role for fungal infections. Because infections in a neutropenic host can be rapidly fatal if not treated, the empiric administration of broad-spectrum intravenous antibiotics is generally indicated for these patients, but it is of paramount importance to consider the local frequencies, susceptibility and resistance patterns of various pathogens. Once therapy has been initiated, it is not indicated to change antibiotics during the initial 5 days unless the patient’s clinical conditions deteriorate considerably. The treatment of invasive fungal infections is particularly troublesome and unfortunately unsuccessful in numerous cases. Further studies are needed to shed light on numerous unclear issues.

Key words
Chemotherapy, bacterial infections, fungal infections, neutropenia, cancer

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Bibliografía del artículo
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Especialidad principal:
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Relacionadas:
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