INFECCIONES BACTERIANAS Y MICOTICAS EN PACIENTES CON CANCER TRATADOS CON QUIMIOTERAPIA




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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
7 de Junio, 2021

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


Artículo completo

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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


Full text
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Especialidades
Principal: Hematología, Oncología
Relacionadas: Bioquímica, Diagnóstico por Laboratorio, Farmacología, Infectología, Inmunología, Medicina Farmacéutica, Medicina Interna



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Bibliografía del artículo
  1. Chabner BA. Anticancer drugs. In: De Vita VT, Hellman S & Rosenberg SA, eds. Cancer: Principles and Practice of Oncology, 4th edn. Lippincott, Philadelphia, PA, 1996: 325-417.
  2. Blay JY, Chauvin F, Le Cesne A, et al. Early lymphopenia after cytotoxic chemotherapy as a risk factor for febrile neutropenia. J Clin Oncol 1996; 14: 636-643.
  3. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64: 328-340.
  4. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention and treatment. Lancet Oncology 2003; 4: 595-604.
  5. Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993; 328: 1323-1332.
  6. Rubin MM, Hathorn JW, Pizzo PA. Controversies in the management of febrile neutropenic cancer patients. Cancer Invest 1988; 6: 167-184.
  7. Talcott JA, Finberg R, Mayer RJ, Goldman L. The medical course of cancer patients with fever and neutropenia: clinical identification of a low-risk subgroup at presentation. Arch Intern Med 1988; 148: 2561-2568.
  8. Talcott JA, Siegel RD, Finberg R, Goldman L. Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol 1992; 10: 316-322.
  9. Malik I, Abbas Z, Karim M. Randomised comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febbrile patients. Lancet 1992; 339: 1092-1096.
  10. Petrilli AS, Cypriano M, Dantas LS, et al. Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma. Braz J Infect Dis 2003; 7: 111-120.
  11. Schimpff SC, Satterlee W, Young VM, Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971; 204: 1061-1065.
  12. Zinner SH. Changing epidemiology of infections in patients with neutropenia and cancer: emphasis on gram-positive and resistant bacteria. Clin Infect Dis 1999; 29: 490-494.
  13. Ariffin H, Navaratnam P, Lin HP. Surveillance study of bacteraemic episodes in febrile neutropenic children. Int J Clin Pract 2002; 56: 237-240.
  14. Viscoli C, Castagnola E. Treatment of febrile neutropenia: what is new Curr Opin Infect Dis 2002; 15: 377-382.
  15. Montecalvo MA, Horowitz H, Gedric C, et al. Outbreak of vancomycin-ampicillin and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994; 38: 1363-1367.
  16. Edmond MC, Ober JF, Weinbaum DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995; 20: 1126-1133.
  17. Groll AH, Shah PM, Mentzel C, Schneider M, Just-Nubling G, Huebner K. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 1996; 33: 23-32.
  18. Denning DW, Evans EGV, Kibbler CC, et al. Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. Eur J Clin Microbiol Infect Dis 1997; 16: 424-436.
  19. Meunier-Carpentier F. Symposium on infectious complications of neoplastic disease (Part II). Chemoprophylaxis of fungal infections. Am J Med 1984; 76: 652-656.
  20. Bodey G, Bueltmann B, Duguid W, et al. Fungal infections in cancer patients: an international autopsy survey. Eur J Clin Microbiol Infect Dis 1992; 11: 99-109.
  21. Wingard JR. Infections due to resistant Candida species in patients with cancer who are receiving chemotherapy. Clin Infect Dis 1994; 19 (Suppl) : S49-S53.
  22. Lentino LR, Rosenkranz MA, Michaels JA, Kurup VP, Rose HD, Rytel MW. Nosocomial aspergillosis. A retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol 1992; 116: 430-437.
  23. Verweij PE, Meis JFGM, Vandenhurk P, De Pauw BE, Hoogkamp-Korstanje JAA, Melchers WJG. Polymerase chain reaction as a diagnostic tool for invasive aspergillosis: evaluation in bronchoalveolar lavage fluid from low risk patients. Serodiagn Immunother Infect Dis 1994; 6: 203-209.
  24. Kontoyiannis DP, lionakis MS, Lewis RE, et al. Zygomycosis in the era of Aspergillus-active antifungal therapy in a tertiary care cancer center: a case-control observational study of 27 recent cases. J Infect Dis 2005; 191: 1350-1360.
  25. DesJarden J, Falagas M, Ruthazer R, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalised patients with cancer. Ann Intern Med 1999; 131: 641-647.
  26. Blot F, Nitenberg G, Chachaty E, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 1999; 354: 1071-1077.
  27. Tacconelli E, Tumbarello M, Pittiruti M, et al. Central venous catheter-related sepsis in a cohort of 366 hospitalised patients. Eur J Clin Microbiol Infect Dis 1997; 16: 203-209.
  28. Douard MC, Arlet G, Longuet P, et al. Diagnosis of venous access port-related infections. Clin Infect Dis 1999; 29: 1197-1202.
  29. Douard MC, Arlet G, Leverger G, et al. Quantitative blood cultures for diagnosis and management of catheter-related sepsis in pediatric haematology and oncology patients. Intensive Care Med 1991; 17: 30-35.
  30. Kite P, Dobbins BM, Wilcox MH, McMahon MJ. Rapid diagnosis of central-venous-catheter-related bloodstream infection without catheter removal. Lancet 1999; 354: 1504-1507.
  31. Jensen HE, Salonen J, Ekfors TO. The use of immunohistochemistry to improve sensitivity and specificity in the diagnosis of systemic mycoses in patients with haematological malignancies. J Pathol 1997; 181: 100-105.
  32. Rodriguez LJ, Rex JH, Anaissie EJ. Update on invasive candidiasis. Adv Pharmacol 1997; 37: 349-400.
  33. Walsh TJ, Chanock SJ. Diagnosis of invasive fungal infections: advances in nonculture systems. Curr Clin Top Infect Dis 1998; 18: 101-153.
  34. Maertens J, Verhaegen J, Demuynck H, et al. Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for haematological patients at risk for invasive aspergillosis. J Clin Microbiol 1999; 37: 3223-3228.
  35. Maertens J, Verhaegen J, Lagrou K, et al. Screening for circulating galactomannan as a non-invasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 2001; 97: 1604-1610.
  36. Ulusakarya A, Chachaty E, Vantelon JM, et al. Surveillance of Aspergillus galactomannan antigenemia for invasive aspergillosis by enzyme-linked immunosorbent assay in neutropenic patients treated for hematological malignancies. Hematol J 2000; 1: 111-116.
  37. Einsele H, Hebart H, Roller G, et al. Detection and identification of fungal pathogens in blood by using molecular probes. J Clin Microbiol 1997; 35: 1353-1360.
  38. Brenier-Pinchart MP, Pelloux H, Lebeau B, Pinel C, Ambroise-Thomas P, Grillot R. Towards a molecular diagnosis of invasive aspergillosis A review of the literature. J Mycol Med 1999; 9: 16-23.
  39. Murphy M, Brown AE, Sepkowitz KA, Bernard EM, Kiehn TE, Armstrong D. Fluoroquinolone prophylaxis for the prevention of bacterial infections in patients with cancer: is it justified Clin Infect Dis 1997; 25: 346-347.
  40. Strausbaugh LJ, Sewell DL, Ward TT, Pfaller MA, Heitzman T, Tjoelker R. High frequency of yeast carriage on hands of hospital personnel. J Clin Microbiol 1994; 32: 2299-2300.
  41. Nuzzi M, Spector N, Bueno AP, et al. Risk factors and attributable mortality associated with superinfections in neutropenic patients with cancer. Clin Infect Dis 1997; 24: 575-579.
  42. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982; 72: 101-111.
  43. European Organisation for Research on Treatment of Cancer. Empiric antifungal therapy in febrile granulocytopenic patients. EORTC International Antimicrobial Therapy Cooperative Group. Am J Med 1989; 86: 668-672.
  44. Prentice HG, Hann IM, Herbrecht R, et al. A randomised comparison of liposomal versus conventional amphotericin B for treatment of pyrexia of unknown origin in neutropenic patients. Br J Haematol 1997; 98: 711-718.
  45. Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med 1999; 340: 764-771.
  46. Boogaerts M, Winston DJ, Bow EJ, et al. Intravenous and oral itraconazole versus intravenous amphotericin B as empirical antifungal therapy for persistent fever in neutropenic patients with cancer who are receiving broad-spectrum antibacterial therapy. Ann Intern Med 2001; 135: 412-422.
  47. Winston DJ, Hathorn JW, Schuster MG, et al. A multicentre, randomised trial of fluconazole vs. amphotericin B for empiric antifungal therapy of febrile neutropenic patients with cancer. Am J Med 2000; 108: 282-289.
  48. Walsh TJ, Pappas P, Winston DJ, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med 2002; 346: 225-234.
  49. Rotstein C, Bow EJ, Laverdiere M, et al. Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. Clin Infect Dis 1999; 28: 331-340.
  50. MacMillan ML, Goodman JL, DeFor TE, Weisdorf DJ. Fluconazole to prevent yeast infections in bone marrow transplantation patients: a randomized trial of high versus reduced dose, and determination of the value of maintenance therapy. Am J Med 2002; 112: 369-379.
  51. Menichetti F, Del Favero A, Martino P, et al. Itraconazole oral solution as prophylaxis for fungal infections in neutropenic patients with hematologic malignancies: a randomised, placebo-controlled, double-blind, multicenter trial. Clin Infect Dis 1999; 28: 250-255.
  52. Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: a prospective, multicentre surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 1999; 28: 1071-1079.
  53. Bodey GP, Mardani M, Hanna HA, et al. The epidemiology of Candida glabrata and Candida albicans fungemia in immunocompromised patients with cancer. Am J Med 2002; 112: 380-385.
  54. Marr KA, Seidel K, White TC, Bowden RA. Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. J Infect Dis 2000; 181: 309-316.
  55. Denning DW. Echinocandins and pneumocandins: a new antifungal class with a novel mode of action. J Antimicrob Chemother 1997; 40: 611-614.
  56. Walsh TJ, Teppler H, Donowitz GR, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in persistently febrile neutropenic patients. N Engl J Med 2004; 351: 1391-1402.
  57. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730-751.
  58. EORTC International Antimicrobial Therapy Cooperative Group. Ceftazidime combined with a short or long course of amikacin for empirical therapy of gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 1987; 317: 1692-1698.
  59. Rolston KVI, Berkley P, Bodey GP, et al. A comparison of imipenem to ceftazidime with or without amikacin as empiric therapy in febrile neutropenic patients. Arch Intern Med 1992; 152: 283-291.
  60. Leibovicz L, Paul M, Poznanski O, et al. Monotherapy versus -lactam-aminoglycoside combination treatment for gram-negative bacteremia: a prospective, observational study. Antimicrob Agents Chemother 1997; 41: 1127-1133.
  61. Bohme A, Shah PM, Stille W, et al. Piperacillin/tazobactam versus cefepime as initial empirical antimicrobial therapy in febrile neutropenia patients: a prospective randomised pilot study. Eur J Med Res 1998; 3: 324-330.
  62. Del Favero A, Menichetti F, Martino P, et al. A multicenter, double-blind, placebo-controlled trial comparino piperacillin-tazobactam with and without amikacin as empiric therapy for febbrile neutropenia. Clin Infect Dis 2001; 33: 1295-1301.
  63. Giamarellou H, Bassaris HP, Petrikkos G, et al. Monotherapy with intravenous followed by oral high-dose ciprofloxacin versus combination therapy with ceftazidime plus amikacin as initial empiric therapy for granulocytopenic patients with fever. Antimicrobial Agents Chemother 2000; 44: 3264-3271.
  64. Jones RN. Contemporary antimicrobial susceptibility patterns of bacterial pathogens commonly associated with febrile patients with neutropenia. Clin Infect Dis 1999; 29: 495-502.
  65. Elting LS, Rubenstein EB, Rolston K, et al. Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implication for quality and cost of care. J Clin Oncol 2000; 18: 3699-3706.
  66. Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis. Clin Infect Dis 2000; 30: 662-678.
  67. Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis 2000; 30: 696-709.
  68. Hiemenz JW, Walsh TJ. Lipid formulations of amphotericin B: recent progress and future directions. Clin Infect Dis 1996; 22 (Suppl 2): S133-S144.
  69. Groll AH, Giri N, Petraitis V, et al. Comparative efficacy and distribution of lipid formulations of amphotericin B in experimental Candida albicans infection of the central nervous system. J Infect Dis 2000; 182: 274-282.
  70. Freifeld AG, Marchigiani D, Walsh T, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med 1999; 341: 305-311.
  71. Kern WV, Cometta A, de Bock R, et al. Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. N Engl J Med 1999; 341: 312-318.

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