Eine Hauptursache von Hospitalisierung und Letalität Immunsupprimierter sind Infektionen.
Deren Management, Prävention und Therapie spielen eine entscheidende Rolle für Überleben
und Lebensqualität. Es existieren zahlreiche Leitlinien und Empfehlungen für das Management
von Infektionen bei Immunsupprimierten. Überschneidungen von Infektiologie, Hygiene,
Hämatologie und Onkologie führen zu teils voneinander abweichenden Empfehlungen. Dieser
Artikel gibt einen Überblick über die aktuell bestehende Evidenz und die Leitlinien
zum Infektionsmanagement bei Immunsupprimierten.
Abstract
The number of immunosuppressed patients continues to increase worldwide. The main
reasons are the demographic development and improved long-term survival, also for
patients under immunosuppression. A major cause of hospitalization and mortality among
these patients are infections. Their management, including prevention and adequate
treatment, plays a crucial role in survival and quality of life, but also with regard
to economic factors.
Infection management in immunocompromised patients faces new challenges today. Not
only the increasing number, but also new groups of patients at risk and an increasingly
aging and comorbid population pose problems for the treating physicians. While cancer
medicine is no longer determined solely by radiotherapy and chemotherapy, new targeted
substances are playing an increasingly important role. In addition, new targeted substances
complicate adequate infection prophylaxis due to potential interactions. The worldwide
increase in antibiotic-resistant pathogens complicates treatment of bacterial infections,
which is associated with increased mortality, especially in the immunocompromised
patient population. Further, the disruption of the microbiome shows negative antibiotic-associated
effects. Hence the reasonable use of anti-infectives in prophylaxis and therapy is
of great importance.
There are many recommendations and guidelines for clinicians regarding the management
of infections in immunocompromised patients. Overlaps of infectiology, hygiene as
well as hematology and oncology sometimes lead to different recommendations. This
article provides an overview of the currently existing evidence and guidelines for
infection management in immunosuppressed patients.
Schlüsselwörter
Immunsuppression - virale Infektionen - bakterielle Infektionen - Pilzinfektionen
- Management
Key words
Immunosuppression - viral infections - bacterial infections - fungal infections -
management
