Dtsch Med Wochenschr 2017; 142(13): 961-968
DOI: 10.1055/s-0042-117248
Dossier

Fieber bei Krebspatienten

Oliver Andreas Cornely
,
Sibylle Christiane Mellinghoff

Fieber ist eine gefährliche Komplikation für Krebspatienten. Oft verlaufen Infektionen symptomarm, weil die Entzündungsreaktion krankheits- und therapiebedingt eingeschränkt ist. Zudem ist die Abwehr auch gegen weniger virulente Pathogene gemindert, sodass ein breites Erregerspektrum abzuklären ist. Fieber unter der Neutropenie heißt: sofortiges Handeln. Dieser Beitrag beschreibt die aktuelle Diagnostik und Therapie.



Publication History

Article published online:
03 July 2017

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia risks, consequences, and new directions for its management. Cancer 2004; 100: 228-237
  • 2 Boada Burutaran M, Guadagna R, Grille S. et al. Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay. Rev Bras Hematol Hemoter 2015; 37: 28-33
  • 3 Portugal RD, Garnica M, Nucci M. Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve. J Clin Oncol 2009; 27: 3849-3854
  • 4 Klastersky J, Paesmans M, Rubenstein EB. et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000; 18: 3038-3051
  • 5 Cornely OA, Schirmacher P. Clinical picture: Bacterial translocation in neutropenic sepsis. Lancet 2001; 358: 1842
  • 6 Teachey DT, Rheingold SR, Maude SL. et al. Cytokine release syndrome after blinatumomab treatment related to abnormal macrophage activation and ameliorated with cytokine-directed therapy. Blood 2013; 121: 5154-5157
  • 7 Maude SL, Barrett D, Teachey DT. et al. Managing cytokine release syndrome associated with novel T cell-engaging therapies. Cancer J 2014; 20: 119-122
  • 8 Augustson BM, Begum G, Dunn JA. et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United kingdom Medical Research Council trials between 1980 and 2002--Medical Research Council Adult Leukaemia Working Party. J Clin Oncol 2005; 23: 9219-9226
  • 9 Rolston KV. Challenges in the treatment of infections caused by gram-positive and gram-negative bacteria in patients with cancer and neutropenia. Clin Infect Dis 2005; 40: S246-S252
  • 10 Viscoli C, Castagnola E. Planned progressive antimicrobial therapy in neutropenic patients. Br J Haematol 1998; 102: 879-888
  • 11 Coullioud D, Van der Auwera P, Viot M. et al. Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. CEMIC (French-Belgian Study Club of Infectious Diseases in Cancer). Support Care Cancer 1993; 1: 34-46
  • 12 Seifert H, Cornely O, Seggewiss K. et al. Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis. J Clin Microbiol 2003; 41: 118-123
  • 13 Cornely OA, Bethe U, Seifert H. et al. A randomized monocentric trial in febrile neutropenic patients: ceftriaxone and gentamicin vs cefepime and gentamicin. Ann Hematol 2002; 81: 37-43
  • 14 Ruping MJ, Keulertz C, Vehreschild JJ. et al. Association of HSV reactivation and pro-inflammatory cytokine levels with the severity of stomatitis after BEAM chemotherapy and autologous SCT. Support Care Cancer 2011; 19: 1211-1216
  • 15 Tacke D, Buchheidt D, Karthaus M. et al. Primary prophylaxis of invasive fungal infections in patients with haematologic malignancies. 2014 update of the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology. Ann Hematol 2014; 93: 1449-1456
  • 16 Kibbler CC. Empirical antifungal therapy in febrile neutropenic patients: current status. Curr Top Med Mycol 1997; 8: 5-14
  • 17 Wingard JR, Leather HL. Empiric antifungal therapy for the neutropenic patient. Oncology (Williston Park) 2001; 15: 351-367
  • 18 Chamilos G, Luna M, Lewis RE. et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989–2003). Haematologica 2006; 91: 986-989
  • 19 Cornely OA, Gachot B, Akan H. et al. Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031). Clin Infect Dis 2015; 61: 324-331
  • 20 Stern A, Green H, Paul M. et al. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. The Cochrane database of systematic reviews 2014;
  • 21 Link H, Bohme A, Cornely OA. et al. Antimicrobial therapy of unexplained fever in neutropenic patients – guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society). Ann Hematol 2003; 82: S105-S117
  • 22 Schiel X, Link H, Maschmeyer G. et al. A prospective, randomized multicenter trial of the empirical addition of antifungal therapy for febrile neutropenic cancer patients: results of the Paul Ehrlich Society for Chemotherapy (PEG) Multicenter Trial II. Infection 2006; 34: 118-126
  • 23 Vehreschild MJ, Vehreschild JJ, Hubel K. et al. Diagnosis and management of gastrointestinal complications in adult cancer patients: evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Oncol 2013; 24: 1189-1202
  • 24 Dellinger RP, Levy MM, Carlet JM. et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008; 34: 17-60
  • 25 Wingard J. Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients). http://www.uptodate.com/contents/treatment-of-neutropenic-fever-syndromes-in-adults-with-hematologic-malignancies-and-hematopoietic-cell-transplant-recipients-high-risk-patients?topicKey=ID%2F1400&elapsedTimeMs=1411&view=print&displayedView=full Stand 27.7.2016
  • 26 Sepkowitz KA. Treatment of patients with hematologic neoplasm, fever, and neutropenia. Clin Infect Dis 2005; 40: S253-S256
  • 27 Lazarus HM, Creger RJ, Gerson SL. Infectious emergencies in oncology patients. Semin Oncol 1989; 16: 543-560
  • 28 Hughes WT, Rivera GK, Schell MJ. et al. Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 1987; 316: 1627-1632
  • 29 Cornely OA, Maertens J, Winston DJ. et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007; 356: 348-359
  • 30 Cornely OA, Duarte RF, Haider S. et al. Phase 3 pharmacokinetics and safety study of a posaconazole tablet formulation in patients at risk for invasive fungal disease. J Antimicrob Chemother 2016; 71: 718-726
  • 31 Maertens J, Verhaegen J, Lagrou K. et al. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 2001; 97: 1604-1610
  • 32 Reich G, Cornely OA, Sandherr M. et al. Empirical antimicrobial monotherapy in patients after high-dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial. Br J Haematol 2005; 130: 265-270
  • 33 Liss BJ, Vehreschild JJ, Cornely OA. et al. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 2012; 40: 613-619
  • 34 Freifeld AG, Bow EJ, Sepkowitz KA. et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52: e56-e93