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Erschienen in: Notfall +  Rettungsmedizin 3/2017

13.01.2017 | Leitthema

Infektionen bei Patienten mit hämatologisch-onkologischen Erkrankungen

verfasst von: PD Dr. med M. Schmidt-Hieber, M. Christopeit, E. Schalk

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 3/2017

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Zusammenfassung

Hintergrund

Infektionen stellen eine häufige und schwerwiegende Komplikation bei Patienten mit hämatologisch-onkologischen Erkrankungen dar, wobei das individuelle Infektionsrisiko von verschiedenen Faktoren, wie z. B. Art der antineoplastischen Therapie bestimmt wird.

Fragestellungen

Zentrale Fragen sind die Bestimmung der Inzidenz von Infektionen bei hämatologisch-onkologischen Patienten sowie Beschreibungen von verursachenden Erregern und Risikofaktoren und Darstellungen von Empfehlungen zur Diagnostik und antimikrobiellen Therapie bei diesen Patienten.

Material und Methoden

Es wurde eine selektive Literaturrecherche durchgeführt und die Expertenempfehlungen diskutiert.

Ergebnisse

Infektionen können bei Tumorpatienten alle Organsysteme betreffen und durch Bakterien, Pilze, Viren und Parasiten verursacht sein. Neben der febrilen Neutropenie werden andere bakterielle und virale Infektionen (z. B. Herpes Zoster) häufig bei diesen Patienten beobachtet. Patienten mit Hochrisikoneutropenie (absolute Neutrophilenzahl <100/µl für >7 Tage) oder Empfänger einer allogenen hämatopoetischen Stammzelltransplantation weisen zudem ein erhöhtes Risiko für mykotische (z. B. pulmonale Aspergillose) sowie parasitäre Infektionen (z. B. ZNS-Toxoplasmose) auf.
Die Diagnostik umfasst Basismaßnahmen (z. B. Entnahme von Blutkulturen) und weitere Untersuchungen, die symptomorientiert durchgeführt werden (z. B. Thorax-CT). In therapeutischer Hinsicht wird ein empirischer von einem präemptiven bzw. einem zielgerichtetem Therapieansatz abgegrenzt.

Schlussfolgerungen

Infektionen tragen wesentlich zur Morbidität und Mortalität von Patienten mit hämatologisch-onkologischen Erkrankungen bei. Die zeitgerechte Einleitung adäquater diagnostischer und therapeutischer Maßnahmen ist entscheidend, um die Mortalität bei diesen Patienten zu reduzieren.
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Metadaten
Titel
Infektionen bei Patienten mit hämatologisch-onkologischen Erkrankungen
verfasst von
PD Dr. med M. Schmidt-Hieber
M. Christopeit
E. Schalk
Publikationsdatum
13.01.2017
Verlag
Springer Medizin
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 3/2017
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-016-0257-3