Antibakterielle Prophylaxe in der Pädiatrischen Hämatologie und Onkologie

Zusammenfassung

Kinder und Jugendliche, die durch eine Krebserkrankung und ihre Therapie immunsupprimiert sind, haben ein hohes Risiko für potentiell lebensbedrohliche Infektionen wie Bakteriämien durch Gram-positive und Gram-negative Erreger. Aus diesem Grunde verabreichen einige Zentren diesen Patienten eine antibakterielle Prophylaxe. Kürzlich wurden 2 Leitlinien zur antibakteriellen Prophylaxe bei Kindern publiziert. Eine dieser Leitlinien wurde durch eine internationale Expertengruppe aus Europa, Nord- und Südamerika sowie Australien erstellt. Die andere Leitlinie wurde durch eine rein europäische Gruppe im Rahmen der achten European Conference on Infections in Leukaemia (ECIL-8) verfasst. In der vorliegenden Übersichtsarbeit stellen die Arbeitsgruppen „Infektionen“ der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) und „Fieber bei Neutropenie“ der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) die wichtigsten Daten von randomisierten Studien, systematischen Reviews und Meta-Analysen zur antibiotischen Prophylaxe als auch von Untersuchungen zur Resistenzentwicklung vor und diskutieren methodologische Aspekte und jeweiligen Empfehlungen der beiden Leitlinien.

Abstract

Immunocompromised children and adolescents receiving treatment for cancer have an increased risk for potentially life-threatening infectious complications such as blood stream infections with Gram-positive and Gram-negative pathogens. Therefore, several centers for Pediatric Hematology and Oncology administer antibacterial prophylaxis to these patients to lower morbidity and mortality. Two pediatric specific guidelines on antibacterial prophylaxis were recently published. One of these guidelines was drawn up by an international group of pediatric experts of Europe, North and South America and Australia. The other guideline was prepared by an European group convened at the Eighth European Conference on Infections in Leukaemia (ECIL-8). In this review article, the working groups “Infections” of the Society of Pediatric Oncology and Hematology (GPOH) and “Fever in the neutropenic host” of the German Society for Pediatric Infectious Diseases” (DGPI) summarize the available data from randomized studies, systematic reviews and meta-analyses on antibacterial prophylaxis as well of current data on the emergence of resistance and discuss methodological aspects and the recommendations of the two guidelines.

Schlüsselwörter

Kind - Krebserkrankung - Bakteriämie - antibakterielle Prophylaxe - Leitlinie

Key words

Child - cancer - bacteremia - antibacterial prophylaxis - guideline

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