Infektionen in der pädiatrischen Onkologie

Zusammenfassung

Infektionen gehören zu den häufigen und auch zu den potenziell lebensbedrohlichen Komplikationen der zytotoxischen Therapie von Krebserkrankungen im Kindesalter. In dieser Übersicht werden Risikofaktoren bei pädiatrisch-onkologischen Patienten, das Spektrum der wichtigsten Infektionserreger, die initial erforderliche Diagnostik und das Management infektiöser Komplikationen beschrieben. Diagnostik und Therapie infektiöser Komplikationen binden einen erheblichen Anteil der personellen und finanziellen Ressourcen in pädiatrischonkologischen Abteilungen. Die strukturellen Voraussetzungen und Prinzipien der empirischen antibakteriellen und antimykotischen Chemotherapie, für die bislang in Deutschland noch keine Konsensusempfehlung vorliegt, werden ebenso diskutiert wie die Problematik nosokomial erworbener Infektionen. Ein Ausblick auf die ambulante Weiterbehandlung von ausgewählten Patienten mit Infektion und niedrigem Risiko einer systemischen Infektionsbeteiligung deutet auf zukünftige Behandlungsstrategien in dieser Patientenpopulation hin.

Summary

Infections are still common and potentially lifethreatening complications of antineoplastic therapy in pediatric oncology patients. This article describes risk factors for infectious events in immunocompromised pediatric oncology patients, causative agents and patterns of infection and the initial clinical and diagnostic evaluation of the febrile neutropenic patient. Today, the management of infectious complications substantially contributes to the personnel requirements and the financial burden of antineoplastic treatment in pediatric cancer units. There is still no official consensus recommendation from German expert organisations considering the current antibacterial and antifungal treatment strategies discussed in this review. The prevention of nosocomially acquired infection is an important task in this high risk population. Considering the actual conditions of insurance and health care for outpatients in Germany, further controlled studies are needed to introduce evidence-based outpatient treatment concepts for pediatric cancer patients at low risk for systemic infection.

Schlüsselwörter

Infektionen - pädiatrische Onkologie

Keywords

Infections - pediatric oncology

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