癌症相关感染预防和治疗汇编.pptVIP

癌症相关感染的预防和治疗 临床药学科李林 内容提要 、癌症相关感染的预防 二、粒缺合并发热的管理 三、特定感染部位的评估和治疗 口感染相关性癌症 口癌症相关性感染 法国国际癌症研究机构(IARC)的研究|·指癌症病人在整个病程中受到包括细菌、 表明,全球每年约200万例新发癌症病例 真菌、病毒及寄生虫等病原体的感染。 与感染相关,占每年新发癌症病例的 据统计,95%以上感染的病原体是细菌 16.1% 其中6065%为G菌,主要为肠杆菌科和 每年约190万例新发癌症病例与幽门螺杆 假单胞菌。 菌(Hp)、乙型肝炎病毒(HBV)、丙 型肝炎病毒(HCV)和人乳头状瘤病毒 粒细胞缺乏导致的感染,它是癌症的常见 (HPV)感染相关,主要为胃癌、肝癌和 并发症,也是癌症病人死亡的常见原因。 子宫颈癌 欠发达国家的感染相关癌症是发达国家的 3 synthetic analysis, Lancet Oncol, 2012, 13(6): p607-615 a review and Global burden of cancers attributable to infections in 2008 易感因素 口与原发性癌症相关的免疫缺陷 CLL、ALL、NHL、MDS、MM 实体瘤(坏死、手术) 癌症进展 口中性粒细胞减少(化疗、放疗) 2.0*10^9Vs05*10^9 口脾脏切除或功能性无脾 发热(50-60%) CDC推荐≤55岁疫苗 败血症(10-20%、0.1*10^9)口免疫抑制剂的使用 口粘膜屏障破坏 激素、氟达拉滨、阿伦 口腔、胃肠道、泌尿系统 单抗 口造血干细胞移植 感染风险因素分级 OVERALL INFECTION DISEASE/ THERAPY EXAMPLES FEVERNEUTROPENIA RISKANTIMICROBIAL CATEGORY See FEV-2 WITH CANCER most solid tumor Anticipated neutropenia less than 7d Viral-None unless prior HSV episode ntermediate Autologous HSCT Usually HIGH, but some experts.Bacterial-Consider fluoroquinolone Multiple myelon pending on patient status Consider fiuconazole during . CLL Purine analogs intermediate Purine analog therapy (ie, fludarabine, risk when used as single agents;mucositis Viral-During neutropenia and at least ipated neutropenia 7 to 10 d chemotherapy regimens, the risk 30 d after HSCT converts to higl Allogeneic HSCT including cord blood Usually HIGH, but significant .Bacterial-Consider fluoroquinolone Fungal-(See INF-2) munosuppressive agents ral-during neutropenia and at least Alemtuzumab therapy status of underlying 30 D after hsct GVHD treated with high dose steroids alignancy nticipated neutropenia greater than 10 感染风险因素分级 RALL INFECTION DISEASE/ THERAPY EXAMPLES ANTIFUNGAL PROPHYLAXIS, k ISK IN PATIENTS WITH CANCER Amphotericin B products (category 2B) AML (neutropenic Amphotericin B products(category 2B) INTERMEDIATE Autologous HSCT with mucositis autologous HSCT without mucositis Consider no prophylaxis(category 2B) Allogeneic HSCT (neutropenic) See Antipne