Klin Padiatr 2001; 213(S1): A22-A37
DOI: 10.1055/s-2001-17500
ORIGINALARBEIT

Georg Thieme Verlag Stuttgart · New York

Chemoprophylaxe bakterieller Infektionskrankheiten in der pädiatrischen Onkologie

Antimicrobial prophylaxis of bacterial infections in pediatric oncology patientsA.  Simon1 , G.  Fleischhack1 , G.  Marklein2 , J.  Ritter3
  • 1Abtl. für pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde des Universitätsklinikums Bonn
  • 2Institut für Medizinische Mikrobiologie und Immunologie des Universitätsklinikums Bonn
  • 3Abtl. für pädiatrische Hämatologie und Onkologie, Klinik und Poliklinik für Kinderheilkunde der Universität Münster
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. September 2001 (online)

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).

Literatur

  • 001 Aquino  V M, Pappo  A, Buchanan  G R, Tkaczewski  I, Mustafa  M M. The changing epidemiology of bacteremia in neutropenic children with cancer.  Pediatr Infect Dis J. 1995;;  14 140-143
  • 002 American Society of Gastrointestinal Endoscopy .Infection Control During Gastrointestinal Endoskopy. Guidelines for Clinical Application. Gastrointestinal Endoscopy 1999; 49: 836-841
  • 003 Balkundi  D R, Murray  D L, Patterson  M J, Gera  R, Scott-Emuakpor  A, Kulkarni  R. Penicillin-resistant Streptococcus mitis as a Cause of Septicemia with Meningitis in Febrile Neutropenic Children.  J Ped Hematol Oncol. 1997;;  19 82-85
  • 004 Barriga  F J, Varas  M, Potin  M, Sapunar  F, Rojo  H, Martinez  A, Capdeville  V, Becker  A, Vial  P A. Efficacy of a Vancomycin Solution to Prevent Bacteremia Associated With an Indwelling Central Venous Catheter in Neutropenic and Non-Neutropenic Cancer Patients.  Med Pediatr Oncol. 1997;;  28 196-200
  • 005 Berner  R, Schumacher  R F, Bartelt  S, Forster  J, Brandis  M. Predisposing Conditions and Pathogens in Bacteremia in Hospitalized Children.  Eur J Clin Microbiol Infect Dis. 1998a;;  17 337-340
  • 006 Berner  R, Sauter  S, Duffner  U, Brandis  M, Niemeyer  C M. Bakteriämie-Episoden bei pädiatrisch onkologischen Patienten, insbesondere durch Streptokokken der Viridans-Gruppe.  Klin Pädiatr. 1998b;;  210 256-260
  • 007 Berner  R. Antimikrobielle Therapie. In Lentze MJ, Schaub J, Schulte FJ, Spranger J (Hrsg). Pädiatrie - Grundlagen und Praxis. 1. Auflage. Springer-Verlag 2000; Kapitel 257,: S 1666
  • 008 Bochud  P Y, Eggiman  P, Calandra  T, Van Melle  G, Sgahfi  L, Francioli  P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors.  Clin Infect Dis. 1994;;  18 25-31
  • 009 Bock  S N, Lee  R E, Fisher  B, Rubin  J T, Schwartzentruber  D J, Wei  J P, Callender  D P, Yang  J C, Lotze  M T, Pizzo  P A. A prospective randomized trial evaluating prophylactic antibiotics to prevent triple-lumen catheter-related sepsis in patients treated with immunotherapy.  J Clin Oncol. 1990;;  8 161-169
  • 010 Bodey  G P, Buckley  M, Sathe  Y S, Freireich  E J. Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia.  Ann Intern Med. 1966;;  64 328-340
  • 011 Burgner  D, Siarakas  S, Eagles  G, McCarthy  A, Bradbury  R, Stevens  M. A prospective study of Clostridium difficile infection and colonization in pediatric oncology patients.  Pediatr Infect Dis J. 1997;;  16 1131-1134
  • 012 Cairo  M S, Spooner  S, Sowden  L, Bennetts  G A, Towne  B, Hodder  F. Long-Term Use of Indwelling Multipurpose Silastic Catheters in Pediatric Cancer Patients Treated With Aggressive Chemotherapy.  J Clin Oncol. 1986;;  4 784-788
  • 013 Castagnola  E, Lanino  E, Garaventa  A, Dini  G, Dall'Orso  S, Carrega  G, Viscoli  C. Prophylaxis of streptococcal bacteremia with oral penicillin V in children undergoing bone marrow transplantation.  Support Care Cancer. 1995;;  3 319-321
  • 014 Chanock  S J, Pizzo  P A. Infectious Complications of Patients Undergoing Therapy for Acute Leukemia: Current Status and Future Prospects.  Seminars in Oncology. 1997;;  24 132-140
  • 015 Chiou  C C, Wong  T T, Lin  H H, Hwang  B, Tang  R B, Wu  K G, Lee  B H. Fungal infection of ventriculoperitoneal shunts in children.  Clin Infect Dis. 1994;;  19 1049-1053
  • 016 Cruciani  M, Concia  E, Navarra  A. Prophylactic cotrimoxazole vs. norfloxacin in neutropenic children: prospective randomized study.  Infection. 1989;;  17 65-69
  • 017 Cruciani  M, Rampazzo  R, Malena  M, Lazzaroni  L, Todesschini  G, Messori  A, Concia  E. Prophylaxis with Fluoroquinolones for Bacterial Infections in Neutropenic Patients: A Meta-Analysis.  Clin Infect Dis. 1996;;  23 795-805
  • 018 Daghistani  D, Horn  M, Rodriguez  Z, Schoenike  S, Toledano  S. Prevention of Indwelling Central Venous Catheter Sepsis.  Med Ped Oncol. 1996;;  26 405-408
  • 019 Daschner  F. Emergence of Resistance during Selective Decontamination of the Digestive Tract (Editorial).  Eur J Clin Microbiol Infect Dis. 1992;;  11 1-3
  • 020 Dellinger  E P, Gross  P A, Barrett  T L, Krause  P J, Martone  W J, McGowan  J E Jr, Sweet  R L, Wenzel  R P. Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America.  Infect Control Hosp Epidemiol. 1994;;  15 182
  • 021 de Vries-Hospers  H G, Sleijfer  D T, Mulder  N H, van der Waaij  D, Neiweg  H O, van Saene  H K. Bacteriological aspects of selective decontamination of the digestive tract as a method of infection prevention in granulocytopenic patients.  Antimicrob Agents Chemother. 1981;;  19 813-20
  • 022 Ebner  W, Forster  D H, Rüden  H, Daschner  F. Evidenzbasierte Empfehlungen zur perioperativen Antibioticaprophylaxe.  Chirurg. 2000;;  71 912-917
  • 023 Ebner  W, Kropec-Hübner  A, Daschner  F D. Bacterial Resistance and Overgrowth due to Selective Decontamination of the Digestive Tract.  Eur J Clin Microbiol Infect Dis. 2000;;  19 243-247
  • 024 Elsner  H A, Sobottka  I, Feucht  H H, Harps  E, Haun  C, Mack  D, Ganschow  R, Laufs  R, Kaulfers  P M. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium at a German University Pediatric Hospital.  Int J Hyg Environ Health. 2000;;  203 147-152
  • 025 Elting  L S, Gerald  P B, Keefe  B H. Septicemia and shock syndrome due to viridans streptococci: A Case Control Study of Predisposing Factors.  Clin Infect Dis. 1992;;  14 1201-1207
  • 026 Engels  E A, Lau  J, Barza  M. Efficacy of Quinolone Prophylaxis in Neutropenic Cancer Patients: A Meta-Analysis.  J Clin Oncol. 1998;;  16 1179-1187
  • 027 Fanci  R, Leoni  F, Bosi  A, Guidi  S, Ciolli  S, Longo  G, Donnini  E, Rossi , Ferrini  P. Chemoprophylaxis of bacterial infections in granulocytopenic patients with ciprofloxacin vs. ciprofloxacin plus amoxicillin.  J Chemother. 1993;;  5 119-123
  • 028 Ferrazzini  G, Klein  J, Sulh  H, Chung  D, Griesbrecht  E, Koren  G. Interaction between trimethoprim-sulfamethoxazole and methotrexate in children with leukemia.  J Pediatr. 1990;;  117 823-826
  • 029 Ford  C D, Reilly  W, Wood  J, Classen  D C, Burke  J P. Oral antimicrobial prophylaxis in bone marrow transplant recipients: randomized trial of ciprofloxacin versus ciprofloxacin-vancomycin.  Antimicrob Agents Chemother. 1998;;  42 1402-1405
  • 030 Freifeld  A, Pizzo  P. Use of fluoroquinolones for empirical management of febrile neutropenia in pediatric cancer patients.  Pediatr Infect Dis J. 1997;;  16 140-146
  • 031 Gerding  D N, Johnson  S, Peterson  L R, Mulligan  M E, Silva  J. Clostridium Difficile-Associated Diarrhea and Colitis.  Infection Control Hosp Epidemiol. 1995;;  16 459-477
  • 032 Gerding  D N. Is there a relationship between vancomycin-resistant enterococcal infection and Clostridium difficile infection?.  Clin Infect Dis. 1997;;  25 Suppl 2 S206-210
  • 033 Gould  I M. A review of the role of antibiotic policies in the control of antibiotic resistance.  JAC. 1999;;  43 459-465
  • 034 Gomez-Martin  C, Sola  C, Hornedo  J, Perea  S, Lumbreras  C, Valenti  V, Arcediano  A, Rodriguez  M, Slaazar  R, Cortes-Funes  H, Hidalgo  M. Rifampicin does not improve the efficacy of quinolone antibacterial prophylaxis in neutropenic cancer patients: results of a randomized clinical trial.  J Clin Oncol. 2000;;  18 2126-2134
  • 035 Graubner  U B, Boos  J, Creutzig  U, Dörffel  W, Lakomek  M, Niemeyer  C, Schrappe  M, Spaar  H J (Arbeitskreis Qualitätssicherung der GPOH) und Belohradsky BH. Die antiinfektiöse Prophylaxe in der pädiatrischen Onkologie.  Klin Pädiatr. 1999;;  211 347-352
  • 036 Green  M. Vancomycin Resistant Enterococci: Impact and Management in Pediatrics.  Adv Pediatr Infect Dis. 1997;;  13 257-277
  • 037 Guiot  H FL, Peters  W G, van den Broek  P J, van der Meer  J WM, Kramps  J A, Willemze  R, van Furth  R. Respiratory failure elicited by streptococcal septicemia in patients with cytosine arabinoside, and its prevention by penicillin.  Infection. 1990;;  18 131-137
  • 038 Guiot  H F, van der Meer  J W, van den Broek  P J, Willemze  R, van Furth  R. Prevention of viridans-group streptococcal septicemia in oncohematologic patients: a controlled comparative study on the effect of penicillin G and cotrimoxazole.  Ann Hematol. 1992;;  64 260-265
  • 039 Guiot  H F, van Furth  R. Selective decontamination in bone marrow transplant recipients.  Epidemiol Infect. 1992;;  109 349-360
  • 040 Guiot  H F, Corel  L J, Vossen  J M. Prevalence of penicillin-resistant viridans streptococci in healthy children and in patients with malignant haematological disorders.  Eur J Clin Microbiol Infect Dis. 1994;;  13 645-650
  • 041 Habscheid  W, Bernhardt  C, Sold  M, Köhler  B, Marx  A, Kunz  E, Müller-Hermelink  H K. Atraumatische Clostridium septicum Infektion bei Granulozytopenie.  Deutsch med Wschr. 1991;;  116 1862-186641a Harbarth S, Dharan S, Liassine N, Herrault P, Auckenthaler R, Pittet D. Randomized. Placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999; 43: 1412 - 1416
  • 042 Henning  K J, Delencastre  H, Eagan  J, Boone  N, Brown  A, Chung  M, Wollner  N, Armstrong  D. Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection.  Pediatr Infect Dis J. 1996;;  15 848-854
  • 043 Henrickson  K J, Shenep  J L, Flynn  P M, Pui  C H. Primary Cutaneous Bacillus cereus Infection in Neutropenic Children.  Lancet. 1989;;  I 601-603
  • 044 Hopkins  H A, Sinkowitz-Cchran  R L, Rudin  B A, Keyserling  H L, Jarvis  W R. Vancomycin Use in Pediatric Hematology-Oncology Patients.  Infect Control Hosp Epidemiol. 2000;;  21 28-50
  • 045 Horvatova  Z, Spanik  S, Sufliarsky  J, Mardiak  J, Pichna  P, Pichnova  E, Krajcik  S, Mraz  M, Chmelik  B, Dacok  J, Beresova  J, Krupova  I, Hrachova  A, Trupl  J, Kunova  A, Krcmery  V. Bacteremia due to methicillin-resistant staphylococci occurs more frequently in neutropenic patients who received antimicrobial prophylaxis and is associated with higher mortality in comparison to methicillin-sensitive Bacteremia.  In J Antimicrob Agents. 1998;;  10 55-58
  • 046 Hospital Infection Control Practices Advisory Committee (HICPAC) .Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol (Internet http://www.cdc.gov) 1995; 16: 105-113
  • 047 Hughes  W T, Kuhn  S, Chaudary  S, Feldman  S, Verzosa  M, Aur  R JA, Pratt  C, George  S L. Successful Chemoprophylaxis for Pneumocystis Carinii Pneumonitis.  N Engl J Med. 1977;;  297 1419-1426
  • 048 Hughes  W T, Rivera  G K, Schell  M J, Thornton  D, Lott  L. Successful Intermittent Chemoprophylaxis for Pneumocystis Carinii Pneumonitis.  N Engl J Med. 1987;;  316 1627-1632
  • 049 Hughes  W T, Armstrong  D, Bodey  G P, Brown  A E, Edwards  J E, Feld  R, Pizzo  P, Rolston  K V, Shenep  J L, Young  L S. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America.  Clin Infect Dis. 1997;;  25 551-573
  • 050 Huovinen  P, Sundstrom  L, Swedberg  G, Skold  O. Trimethoprim and sulfonamide resistance.  Antimicrob Agents Chemother. 1995;;  39 279-289
  • 051 Imrie  K R, Prince  H M, Couture  F, Brandwein  J M, Keating  A. Effect of antimicrobial prophylaxis on hematopoietic recovery following autologous bone marrow transplantation: ciprofloxacin versus co-trimoxazole.  Bone Marrow Transplant. 1995;;  15 267-270
  • 052 Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy .Antimicrobial prophylaxis in neurosurgery and after head injury. Lancet 1994; 344: 1547-1551
  • 053 Infektionsschutzgesetz .Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz - IfSG). Bundesgesetzblatt Teil 1 Nr. 3, Bonn; 25. Juli 2000:
  • 054 International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer (EORTC) .Reduction of fever and streptococcal bacteremia in granulocytopenic patients with cancer. A trial of oral penicillin V or placebo combined with pefloxacin. JAMA 1994; 272: 1183-1189
  • 055 Johnson  D M, Jones  R N, Erwin  M E. Anti-streptococcal activity of SB-265 805 (LB 20 304), a novel fluoronaphthyridone, compared with five other compounds, including quality control guidelines.  Diagn Microbiol Infect Dis. 1999;;  33 87-91
  • 056 Jones  R N. Contemporary antimicrobial susceptibility patterns of bacterial pathogens commonly associated with febrile patients with neutropenia.  Clin Infect Dis. 1999;;  29 495-502
  • 057 Kaufhold  A, Behrendt  W, Krauss  T, van Saene  H. Selective decontamination of the digestive tract and methicillin-resistant Staphylococcus aureus.  Lancet. 1992;;  339 1411-1412
  • 058 Kern  W, Kurrle  E, Schmeiser  T. Streptococcal Bacteremia in adult patients with leukemia undergoing aggressive chemotherapy: a review of 55 cases.  Infection. 1990;;  18 138-145
  • 059 Kern  W V, Andriof  E, Oethinger  M, Kern  P, Hacker  J, Marre  R. Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center.  Antimicrob Agents Chemother. 1994;;  38 681-687
  • 060 Kern  W V, Hay  B, Kern  P, Marre  R, Arnold  R. A randomized trial of roxithromycin in patients with acute leukemia and bone marrow transplant recipients receiving fluoroquinolone prophylaxis.  Antimicrob Agents Chemother. 1994;;  38 465-472
  • 061 Kerr  K G. The prophylaxis of bacterial infections in neutropenic patients.  JAC. 1999;;  44 587-591
  • 062 Knippschild  M, Schmid  E N, Uppenkamp  M, Konig  E, Meusers  P, Brittinger  G, Hoffkes  H G. Alcalagines xylosoxidans subsp. xylosoxidans in neutropenic patients.  Oncology. 1996;;  53 258-262
  • 063 Kotilainen  P, Nikoskelainen  J, Huovinen  P. Emergence of ciprofloxacin-resistant coagulase-negative staphylococcal skin flora in immunocompromised patients receiving ciprofloxacin.  J Infect Dis. 1990;;  161 41-44
  • 064 Krcmery  V, Pichna  P, Oravcova  E. Stenotrophomonas maltophilia Bacteremia in cancer patients: report on 31 cases.  J Hosp Infect. 1996;;  34 75-77
  • 065 Krishnan  K, Krishnaswamy  G. Severe bactrim-induced neutropenia with reversal of CD4 +/CD8 + lymphocyte ratio: response to recombinant human granulocyte-colony stimulating factor (R-metHUG-CSF).  Clin Lab Haematol. 1998;;  20 187-188
  • 066 Krupova  Y, Novotny  J, Sabo  A, Mateicka  F, Krcmery  V. Aetiology, cost of antimicrobial therapy and outcome in neutropenic patients who developed bacteriaemia during antimicrobial prophylaxis: a case-control study.  Int J Antimicrob Agents. 1998;;  10 313-316
  • 067 Lamy  T, Michelet  C, Dauriac  C, Grulois  I, Donio  P Y, Le Prise  P Y. Benefit of prophylaxis by intravenous systemic vancomycin in granulocytopenic patients: a prospective randomized trial among 59 patients.  Acta Haematol. 1993;;  90 109-113
  • 068 Langley  J M, LeBlanc  J C, Drake  J, Milner  R. Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis.  Clin Infect Dis. 1993;;  17 98-103
  • 069 Levy  I, Leibovici  L, Drucker  M, Samra  Z, Konisberger  S, Ashkenazi  S. A prospective study of gram-negative Bacteremia in children.  Pediatr Infect Dis. 1996;;  15 117-122
  • 070 Lew  M A, Kehoe  K, Ritz  J, Antman  K H, Nadler  L, Kalish  L A, Finberg  R. Ciprofloxacin versus trimethoprim/sulfamethoxazole for prophylaxis of bacterial infections in bone marrow transplant recipients: a randomized, controlled trial.  J Clin Oncol. 1995;;  13 239-250
  • 071 Lowy  F D. Medical Progress: Staphylococcus aureus Infection. N Engl J Med 1998; 339: 520 - 53271a McGowan JE, Tenover FC. Control of Antimicrobial Resistance in The Health Care System.  Infect Dis Clin North Am. 1997;;  11 311
  • 072 McKee  R, Dunsmuir  R, Whitby  M, Garden  O J. Does antibiotic prophylaxis at the time of catheter insertion reduce the incidence of catheter-related sepsis in intravenous nutrition?.  J Hosp Infect. 1985;;  6 419-425
  • 073 McWhinney  P HM, Kibbler  C C, Gillespie  S H, Patel  S, Morrison  D, Hoffbrand  A V, Prentice  H G. Stomatococcus mucilaginosus: An Emerging pathogen in neutropenic patients.  Clin Infect Dis. 1992;;  14 641-646
  • 074 Meirovich  J, Kitai-Cohen  Y, Keren  G, Fiendler  G, Rubinstein  E. Cerebrospinal fluid shunt infections in children.  Pediatr Infect Dis J. 1987;;  6 921-924
  • 075 Mooney  B R, Reeves  S A, Larson  E. Infection control and bone marrow transplantation.  Am J Infect Control. 1993;;  21 131-138
  • 076 Morrison  V A, Peterson  B A, Bloomfield  C D. Nosocomial septicemia in the cancer patient: the influence of central venous access devices, neutropenia and type of malignancy.  Med Pediatr Oncol. 1990;;  18 209-216.
  • 077 Murray  B E. Vancomycin-Resistant Enterococcal Infections.  N Engl J Med. 2000;;  342 710-721
  • 078 Nourse  C, Murphy  H, Byrne  C, O'meara  A, Bretnach  F, Kaufmann  M, Clarke  A, Butler  K. Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors of colonisation.  Eur J Pediatr. 1998;;  157 20-27
  • 079 Oethinger  M, Conrad  S, Kaifel  K, Cometta  A, Bille  J, Klotz  G, Glauser  M P, Marre  R, Kern  W V. Molecular epidemiology of fluoroquinolone-resistant Escherichia coli bloodstream isolates from patients admitted to European cancer centers.  Antimicrob Agents Chemother. 1996;;  40 387-392
  • 080 Oethinger  M, Jellen-Ritter  A S, Conrad  S, Marre  R, Kern  W V. Colonization and infection with fluoroquinolone-resistant Escherichia coli among cancer patients: clonal analysis.  Infection. 1998;;  26 379-384
  • 081 Oppenheim  B A, Hartley  J W, Lee  W, Burnie  J P. Outbreak of coagulase-negative staphylococcus highly resistant to ciprofloxacin in a leukaemia unit.  BMJ. 1989;;  299 294-297
  • 082 Patrick  C C, Adair  J R, Warner  W C. Safety of ciprofloxacin as a prophylactic agent for prevention of Bacteremia infections in pediatric bone marrow transplantat (BMT) patients. [Abstract LM 17]. In: Program and abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Washington D.C.; 1995;: 329
  • 083 Patrick  C C. Use of fluoroquinolones as prophylactic agents in patients with neutropenia.  Pediatr Infect Dis J. 1997;;  16 135-139
  • 084 Pearson  M L and The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of intravascular device-related infections.  Am J Infect Control. (im Internet http://www.cdc.gov)  1996;;  24 262-293
  • 085 Pegues  D A, Carson  L A, Anderson  R L. Outbreak of Pseudomonas cepacia in oncology patients.  Clin Infect Dis. 1993;;  16 407-411
  • 086 Penzak  S R, Gubbins  P O, Stratton  S L, Anaissie  E J. Investigation of an outbreak of gram-negative Bacteremia among hematology-oncology outpatients.  Infect Contr Hosp Epidemiol. 2000;;  21 597-599
  • 087 Pignon  B, Thiriet  L, Aubert  D, Pennaforte  J L, Vilque  J P, Lartigue  B, Jolly  D, Bajolet-Laudinat  O, Etienne  J C. Evaluation of the efficacy of prophylactic intravenous antibiotherapy with ceftriaxone in postchemotherapy agranulocytic patients.  Nouv Rev Fr Haematol. 1990;;  32 249-252
  • 088 Pizzo  P A, Ladisch  S L, Gill  F A. Increasing incidence of gram positive sepsis in cancer patients.  Med Pediatr Oncol. 1978;;  5 241-244
  • 089 Pizzo  P A. The value of protective isolation in preventing nosocomial infections in high risk patients.  Am J Med. 1981;;  70 631-637
  • 090 Pizzo  P A, Schimpff  S C. Strategies for the Prevention of Infection in the Myelosuppressed or Immunosuppressed Cancer Patient.  Cancer Treat Rep. 1983;;  67 223-234
  • 091 Pizzo  P A. Considerations for the prevention of infectious complications in patients with cancer.  Rev Infect Dis. 1989;;  11 Suppl 7 S1551-1563
  • 092 Pizzo  E A, Rubin  M, Freifeld  A, Walsh  T J. The child with cancer and infection. I. Empiric therapy for fever and neutropenia, and preventive strategies.  J Pediatr. 1991;;  119 679-694
  • 093 Perera  S, Hidalgo  M, Arcediano  A, Ramos  M, Gomez  C, Hornedo  J, Lumbreras  C, Folgueira  D, Cortes-Funes  H, Rodriguez-Noriega  A. Incidence and clinical impact of fluoroquinolone-resistant Escherichia coli in the faecal flora of cancer patients treated with high does chemotherapy and ciprofloxacin prophylaxis.  J Antimicrob Chemother. 1999;;  44 117-120
  • 094 Preclik  G, Grüne  S, Leser  H G, Lebherz  J, Heldwein  W, Machka  K, Holstege  A, Kern  W V. Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy.  BMJ. 1999;;  319 881-884
  • 095 Rackoff  W R, Weiman  M, Jakobowski  D, Hirschl  R, Stallings  V, Bilodeau  J, Danz  P, Bell  L, Lange  B. A randomised, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children.  J Pediatr. 1995;;  127 147-151
  • 096 Ranson  M R, Oppenheim  B A, Jackson  A, Kamthan  A G, Scarffe  J H. Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients.  J Hosp Infect. 1990;;  15 95-102
  • 097 Richard  P, Amador del Valle  G, Moreau  P, Milpied  N, Felice  M P, Daeschler  T, Harousseau  J L, Richet  H. Viridans streptococci in patients with neutropenia.  Lancet. 1995;;  345 1607-1609
  • 098 Rieske  K, Handrick  W, Spencker  F B, Günther  E. Sepsis durch vergrünende Streptokokken bei Kindern mit malignen hämatologischen Erkrankungen.  Klin Pädiatr. 1997;;  209 364-372
  • 099 Ringden  O, Heimdahl  A, Lönnquist  B, Malmborg  A S, Wilczek  H. Decreased incidence of viridans streptococcal septicemia in allogenic bone marrow transplant recipients after the introduction of acyclovir.  Lancet. 1984;;  I 744
  • 100 Risi  G F, Tomascak  V. Prevention of infection in the immunocompromised host.  Am J Infect Control. 1998;;  26 594-605
  • 101 Ritter  E, Thurm  V, Bauernfeind  A, Dorittke  C, Völpel  S, Finger  H. Nosocomial colonization and infection caused by multiresistant Enterobacter cloacae strains in a pediatric oncology ward.  Zbl Hyg. 1994;;  196 81-94
  • 102 Ritter  J. Pediatric Update: Acute Myeloid Leukaemias.  Eur J Cancer. 1998;;  34 862-872
  • 103 Robert-Koch-Institut, Kommission für Krankenhaushygiene und Infektionsprävention .Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten-Staphylococcus aureus Stämmen (MRSA) in Krankenhäusern und anderen medizinischen Einrichtungen. (1999) (Internet http://www.rki.de/GESUND/HYGIENE/HYGIENE.HTM). 
  • 104 Robert-Koch-Institut Berlin .Surveillance nosokomialer Infektionen sowie die Erfassung von Erregern mit speziellen Resistenzen und Multiresistenzen. § 6 Abs. 3 und § 23 Abs. 1 und 2 in Verbindung mit § 4 Abs. 2 Nr. 2 IfSG. Rechtliche Voraussetzungen und Umsetzungsempfehlungen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2000; 43: 887-890
  • 105 Rodgers  G L, Mortensen  J E, Blecker-Shely  D, Fisher  M C, Long  S S. Two case reports and review of vascular catheter-associated Bacteremia caused by nontuberculous Mycobacterium species.  Pediatr Infect Dis J. 1996;;  15 260-264
  • 106 Saavedra  J, Rodriguez  J N, Fernandez-Jurado  A, Vega  M D, Pascual  L, Prados  D. Necrotic soft-tissue lesion due to Corynebacterium urealyticum in a neutropenic child.  Clin Infect Dis. 1996;;  22 851-852
  • 107 Schaad  U B. Role of the new quinolones in pediatric practice.  Pediatr Infect Dis J. 1992;;  11 1043-1046
  • 108 Schaison  G, Baruchei  A, Ariet  G. Prevention of gram-positive and Candida albicans infections using teicoplanin and fluconazole: a randomized trial in neutropenic patients.  Br J Haematol. 1990;;  76: Suppl 2 24-26
  • 109 Schimpff  S C, Satterlee  W, Young  V M, Serpick  A. Empiric Therapy with carbenicillin and gentamycin for febrile patients with cancer and granulocytopenia.  N Engl J Med. 1971;;  284 1061-1065
  • 110 Schimpff  S C, Young  V, Greene  W, Vermeulen  G D, Moody  M R, Wiernik  P H. Origin of infection in acute nonlymphocytic leukemia: significance of hospital acquisition of potential pathogens.  Ann Intern Med. 1972;;  77 707-714
  • 111 Schimpff  S C, Scott  D A, Wade  J C. Infections in cancer patients: some controversial issues. Support Care Cancer 1994; 2: 94 - 104111a Schots R, Trullemans F, van Riet I, Kaufman L, Hafsia A, Meddeb B, Hadj Ali ZB, Ben Abid H, Lauwers S, van Camp B. The clinical impact of early gram-positive bacteremia and the use of vancomycin after allogenic bone marrow transplantation.  Transplantation. 2000;;  69 1511-1514
  • 112 Schuster  F, Graubner  U B, Schmid  I, Weiss  M, Belohradsky  B H. Vancomycin-resistant-enterococci - Colonisation of 24 Patients in a pediatric oncology unit.  Klin Pädiatr. 1998;;  210 261-263
  • 113 Schwalbe  R S, Stapleton  J T, Gilligan  P H. Emergence of Vancomycin Resistance in Coagulase-Negative Staphylococci. N Engl J Med 1987; 316: 927 - 931113a Schwarz C, Henrickson KJ, Roghmann K, Powell K. Prevention of Bacteremia Attributed to Luminal Colonization of Tunneled Central Venous Catheters With Vancomycin-Susceptible Organisms.  J Clin Oncol. 1990;;  8 1591-1597
  • 114 Serody  J S, Shea  T C. Prevention of infections in bone marrow transplant recipients.  Infect Dis Clin North Am. 1997;;  11 459-477
  • 115 Shah  S S, Sinkowitz-Cochran  R L, Keyserling  H L, Jarvis  W R. Vancomycin use in pediatric neurosurgery patients.  Am J Infect Control. 1999;;  27 482-487
  • 116 Shay  D K, Goldmann  D A, Jarvis  W R. Reducing the Spread of Antimicrobial-Resistant Microorganisms: Control of Vancomycin-Resistant Enterococci.  Pediatr Clin North Am. 1995;;  42 703-716
  • 117 Shlaes  D M, Gerding  D N, John  J F, Vraig  W A, Bornstein  D L, Duncan  R A, Eckman  M R, Farrer  W E, Green  W H, Lorian  V, Levy  S, McGowan  J E, Paul  S M, Ruskin  J, Tenover  F C, Watanakunakorn  C. Society of Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: Guidelines for the Prevention of Resistance in Hospitals.  Clin Infect Dis. 1997;;  25 584-599
  • 118 Simon  A, Fleischhack  G, Hasan  C, Marklein  G, Bode  U. Clostridium-difficile-assoziierte Diarrhoe bei pädiatrischen Patienten - Vorkommen, Therapieindikationen und Behandlungsstrategie.  Hyg Med. 1998;;  23 109-114
  • 119 Simon  C, Stille  W. Antibiotika-Therapie in Klinik und Praxis. 10. Auflage. Schattauer Verlag, Stuttgart, New York; 1999:
  • 120 Sitges-Serra  A, Girvent  M. Catheter-related Bloodstream Infections.  World J Surg. 1999;;  23 589-595
  • 121 Schots  R, Trullemans  F, Van Riet  I, Kaufman  L, Hafsia  A, Meddeb  B, Hadj Ali  Z B, Ben Abid  H, Lauwers  S, Van Camp  B. The clinical impact of early gram-positive Bacteremia and the use of vancomycin after allogenic bone marrow transplantation.  Transplantation. 2000;;  69 1511-1514
  • 122 Schwartz  C, Henrickson  K J, Roghman  K, Powell  K. Prevention of Bacteremia attributed to luminal colonization of tunneled central venous catheters with Vancomycin-susceptible organisms.  J Clin Oncol. 1990;;  8 1591-1597
  • 123 Tauro  S, Dobie  D, Richardson  G, Hastings  M, Mahendra  P. Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma.  Bone Marrow Transplant. 2000;;  26 1017-1019
  • 124 Teinturier  C, Hartmann  O, Lemerle  J, Benhamou  E, Maraninchi  D. Prevention of gram-positive infections in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomized controlled trial of vancomycin.  Pediatr Hematol Oncol. 1995;;  12 73-77
  • 125 Van der Ven  A J, Koopmans  P P, Vree  T B, van der Meer  J W. Adverse reactions to co-trimoxazole in HIV infection.  Lancet. 1991;;  338 431-433
  • 126 Van der Waaij  D, Berghuis  D JM, Lekkerkerk  J EC. Colonisation resistance in the digestive tract in mice during systemic antibiotic treatment.  J Hyg (Lond). 1972;;  70 605
  • 127 Verhoef  J, Rozenberg-Arska  M, Dekker  A. Prevention of Infection in the Neutropenic Patient.  Rev Infect Dis. 1989;;  11 Suppl 7 S1545-S1550
  • 128 Viot  M, Klastersky  J. Prophylaxis and empiric therapy for streptococcal infections in febrile neutropenic patients.  Eur J Cancer. 1991;;  27 818-819
  • 129 Vollard  E J, Clasener  H A. Colonisation resistance.  Antimicrob Agents Chemother. 1994;;  38 409-414
  • 130 Ward  M S, Lam  K V, Cannell  P K, Herrmann  R P. Mycobacterial central venous catheter tunnel infection: a difficult problem.  Bone Marrow Transplantation. 1999;;  24 325-329
  • 131 Wehl  G, Allerberger  F, Heitger  A, Meister  B, Mauerer  K, Fink  F M. Trends in infection morbidity in a pediatric oncology ward, 1986 - 1995.  Med Pediatr Oncol. 1999;;  32 336-342
  • 132 Weinstein  M R, Dedier  H, Brunton  J, Campbell  I, Conly  J M. Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium.  Clin Infect Dis. 1999;;  29 361-366
  • 133 Wilson  J M, Guiney  D G. Failure of Oral Trimethoprim-Sulfamethoxazole Prophylaxis in Acute Leukemia.  N Engl J Med. 1982;;  306 16-20
  • 134 Winston  D J, Ho  W G, Nakao  S L, Gale  R P, Champlin  R E. Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients.  Am J Med. 1986;;  80 884-890
  • 135 Winston  D J, Ho  W G, Bruckner  D A, Gale  R P, Champlin  R E. Ofloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients.  Am J Med. 1990;;  88 36-42
  • 136 Winston  D J, Emmanouilides  C, Kroeber  A, Hindler  J, Bruckner  D A, Territo  M C, Busuttil  R W. Quinupristin/Dalfopristin therapy for infections due to vancomycin-resistant Enterococcus faecium.  Clin Infect Dis. 2000;;  30 790-797
  • 137 Zinner  S H. Changing Epidemiology of Infections in Patients with Neutropenia and Cancer: Emphasis on Gram-Positive and Resistant Bacteria.  Clin Infect Dis. 1999;;  29 490-494

Dr. med. Arne Simon

Abteilung für pädiatrische Hämatologie und Onkologie
Zentrum für Kinderheilkunde

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53113 Bonn

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