2 results
86 - Infections in patients with neoplastic disease
- from Part XI - The susceptible host
-
- By Amar Safdar, NYU Langone Medical Center, NYU School of Medicine, Donald Armstrong, Memorial Sloan-Kettering Cancer Center
- Edited by David Schlossberg, Temple University, Philadelphia
-
- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 558-562
-
- Chapter
- Export citation
-
Summary
Patients with neoplastic disease and suspected infection require the following main factors to be considered in their evaluation: (1) geographic predisposition for exposure to and to acquire infection including prior colonization with drug-resistant organisms and alteration in hosts’ microbiota; (2) known and unrecognized immune defect or defects due to underlying malignancy or antineoplastic therapy, or both (Table 86.1); (3) breakthrough infections due to drug-resistant pathogens in patients receiving antimicrobial chemoprophylaxis, and (4) familial/genetic predisposition to certain infections in the immunocompromised host. The febrile cancer patient may also have fever from noninfectious conditions such as tumor fever or drug fever. After evaluation, the next question is whether to treat empirically.
EPIDEMIOLOGY
People may be exposed to a variety of organisms through travel, work, habits, or hobbies; in the home; or in other hospitals, outpatient clinics, and infusion centers. A person with children at home is likely to be exposed to a number of infectious agents such as influenza, parainfluenza, respiratory syncytial virus, varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), and cytomegalovirus (CMV). Hospitals are a rich source of antibiotic-resistant microorganisms, including multidrug-resistant Staphylococcus aureus (MRSA), vancomycin-resistant and/or vancomycin-tolerant Enterococcus species, multidrug-resistant Pseudomonas and Stenotrophomonas, and extended-spectrum β-lactamase producing Enterobacteriaceae such as Escherichia coli and Klebsiella species. The recent global spread of carbapenem-resistant Enterobacteriaceae (CRE) has underscored the limitations of antibiotic regimens.
85 - Infections in Patients with Neoplastic Disease
- from Part XI - The Susceptible Host
-
- By Amar Safdar, M. D. Anderson Cancer Center, Donald Armstrong, Memorial Sloan-Kettering Cancer Center
- Edited by David Schlossberg
-
- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 601-604
-
- Chapter
- Export citation
-
Summary
Patients with neoplastic disease and suspected infection come to the physician with the following main factors to be considered in their evaluation: (1) their epidemiologic background and (2) their known and unrecognized immune defect or defects including history of recurrent infections and familial/genetic predisposition to certain infections (Table 85.1). The febrile cancer patient raises the question whether the fever is caused by the neoplasm. After evaluation, the next question is whether to treat empirically. In this chapter, an approach to these patients is outlined, stressing the individuality of each patient along with the complexity of the evaluation.
EPIDEMIOLOGY
People may be exposed to a variety of organisms through travel, work, habits, or hobbies; in the home; or in other hospitals, outpatient clinics, and infusion centers. The right questions must be asked about their background. A person with children at home is likely to be exposed to a number of infectious agents such as influenza, parainfluenza, respiratory syncytial virus, varicella-zoster virus (VZV), human herpesvirus 6 (HHV6), and cytomegalovirus (CMV). Hospitals are a rich source of antibiotic-resistant microorganisms, including multidrug-resistant Staphylococcus aureus (MRSA), vancomycin-resistant and/or vancomycin- tolerant Enterococcus species, multidrugresistant Pseudomonas, Stenotrophomonas, and extended-spectrum β-lactamase-producing Enterobacteriaceae such as Escherichia coli and Klebsiella species. It is important to know where an individual has been hospitalized and what resistance patterns are known to inhabit that hospital. Furthermore, as the spectrum of infection continues to change, it is imperative to follow these trends; just as community-acquired MRSA has recently surpassed hospitalization as a more common source of these resistant bacteria, other traditional risk factors for acquiring an infection may also change.