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DOI: 10.1055/s-2001-17500
Georg Thieme Verlag Stuttgart · New York
Chemoprophylaxe bakterieller Infektionskrankheiten in der pädiatrischen Onkologie
Antimicrobial prophylaxis of bacterial infections in pediatric oncology patientsPublikationsverlauf
Publikationsdatum:
27. September 2001 (online)
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Zusammenfassung.
Die Prävention bakterieller Infektionen ist von vorrangiger
Bedeutung für die Morbidität und Letalität immunsupprimierter
Patienten in der pädiatrischen Onkologie. Mit unterschiedlicher Evidenz
können für die antibakterielle Chemoprophylaxe (ABCP) folgende
Empfehlungen für pädiatrischonkologische Patienten ausgesprochen
werden: Bei Implantation eines ventrikuloperitonealen Shunts (oder eines
ventrikulären Reservoirs) wird eine perioperative antimikrobielle
Prophylaxe empfohlen (IB). Zur Prävention systemischer Infektionen mit
Streptococcus viridans sollten bei Patienten nach einer
Knochenmarktransplantation eine Prophylaxe mit Penicillin erwogen werden, wenn
es sich bei den Isolaten häufiger und schweren Infektionen
überwiegend um penicillinsensible S. viridans handelt (IIIC).
Pädiatrisch-onkologische Abteilungen müssen ein zeitnahes Monitoring
der bakteriellen Resistenzsituation nach dem Infektionsschutzgesetz
durchführen (IB, IV). Das Risiko der Besiedlung und Infektion mit
resistenten Bakterienstämmen muss gegen den objektiven Nutzen der ABCP
abgewogen werden (IB). Nicht empfohlen werden die perioperative antibiotische
Prophylaxe bei Implantation eines getunnelten oder vollständig subkutan
gelegenen zentralen Venenkatheters (IIID) und die antibakterielle Prophylaxe
ZVK-assoziierter Infektionen durch den Zusatz von Vancomycin zur
Katheterspüllösung (IB). Ebenso kann eine orale antibakterielle
Prophylaxe mit nicht resorbierbaren Antibiotika auf der Grundlage der bislang
vorliegenden Studien auch für pädiatrische Patienten mit lang
anhaltender, hochgradiger Granulozytopenie nicht empfohlen werden (IC). Die
bisher verfügbaren Studien sprechen gegen den Nutzen einer
antibakteriellen Chemoprohylaxe mit Trimethoprim-Sulfamethoxazol für
neutropenische Patienten in der pädiatrischen Onkologie (die
PCP-Prophylaxe bleibt davon unberührt) (ID). Für oder gegen die
antibakterielle Chemoprophylaxe mit (den in der Pädiatrie bislang nicht
zugelassenen) Fluorchinolonen kann keine Empfehlung abgegeben werden (IIIC).AbkürzungenABCP Antibakterielle
Chemoprophylaxe
ARA-C Cytosin Arabinosid
CPX
Ciprofloxacin
ESBL Betalaktamase mit erweitertem
Spektrum
FCH Fluorchinolone
HWK
Harnwegskatheter
KMT Knochenmarktransplantation
KNS
Koagulase-negative Staphylokokken
MR-KNS Methicillin-resistente
koagulasenegative Staphylokokken
MRSA Methicillinresistenter
Staphylococcus aureus
MRSE Methicillinresistenter Staphylococcus
epidermidis
PCP Pneumocystis-carinii-Pneumonie
RKI
Robert-Koch-Institut, Berlin
TMS Trimethoprim-Sulfamethoxazol
(Cotrimoxazol)
SDD Selektive Darmdekontamination
VAN
Vancomycin
VRE Vancomycinresistente Enterokokken
ZVK
Zentraler Venenkatheter
Bacterial infections are still a major challenge in the treatment of pediatric cancer patients. Considering the evidence in the literature and published consensus opinions of experts the following strategies of antibacterial chemoprophylaxis (ABCP) in pediatric cancer patients can be recommended (or not recommended): Accompanying the implantation of a ventriculoperitoneal shunt (or a Rickham-reservoir) ABCP is recommended, until prospective controlled studies including pediatric cancer patients have investigated this issue. In bone marrow or stem cell transplant recipients, the prophylactic administration of penicillin should be considered, if severe oral mucositis is a common adverse event in cancer departments with high rates of penicillin-susceptible strains of Streptococcus viridans. Prospective surveillance of resistant bacterial pathogens should be an indispensable tool of quality control in pediatric oncology departments. The risk of infection with antimicrobial-resistant isolates should be balanced against the real benefit of antimicrobial prophylaxis in every instance. ABCP should neither be given during implantation nor during prolonged usage to prevent bacterial infection of a central venous access device (unproven efficacy and potential hazards of Vancomycin-resistant gram-positive infections). The oral administration of non-absorbable ABCP or Trimetoprim-Sufomethoxazole is not recommended for the prevention of bacterial infections (unproven efficacy) and no recommendation can be given for the oral ABCP with chinolones (lacking data, risk of antimicrobial resistance).
Schlüsselwörter
Antibakterielle Chemoprophylaxe - pädiatrische Onkologie
Key words
Antibacterial chemoprophylaxis - pediatric oncology
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Dr. med. Arne Simon
Abteilung für pädiatrische Hämatologie und
Onkologie
Zentrum für Kinderheilkunde
Adenauerallee 119
53113 Bonn
Telefon: 02 28/2 87 32 54
Fax: 02 28/2 87 33 01
eMail: Dr.med.A.Simon@t-online.de