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Prophylaxis

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Managing Infections in Patients With Hematological Malignancies

Part of the book series: Contemporary Hematology ((CH))

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Abstract

Neutropenic states are most often a function of haematopoietic failure secondary to myelophthisic disease or cytotoxic therapy for malignant and nonmalignant conditions. Patients so affected are susceptible to a rather wide spectrum of potentially life-threatening infections due to pathogens (bacterial fungal and viral) with a risk inversely proportional to the severity and duration of neutropenia. Strategies designed to prevent these infections have required an understanding of the normal human microbial ecology, the pathogenesis of the specific infection, and the pathogenesis of the neutropenic state. Fluroquinolone-based antibacterial chemoprophylaxis has been successful in reducing the incidence of febrile neutropenic episodes; documented bacterial infections, particularly gram-negative bacteraemia; infection-related mortality; and, all-cause mortality over the course of the neutropenic period. Success has been confounded by the prevalence of fluroquinolone resistance among gram-negative bacilli in the population at risk. Fluconazole-based antifungal prophylaxis has been successful in reducing invasive fungal infection, particularly due to fluconazole-susceptible Candida spp., but has had no effect on the incidence of filamentous fungal infections. Some studies have been able to demonstrate effects of reducing fungal infection-related mortality and all-cause mortality. Mold-active extended-spectrum azole antifungal agents such as posaconazole or voriconazole have been successful in reducing infections due to Aspergillus spp. Antiviral chemoprophylaxis targeting Herpes group viruses, particularly Herpes simplex virus and Human Cytomegalovirus, have been successful in reducing clinical disease in hematopoietic stem cell transplantation. The success of any given preventive strategy is directly related to the selection of the most appropriate risk group for application, the duration of time over which the risk applies, and the prevalence of resistance to the strategy among the pathogens of concern.

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  1. Health Sciences Centre, Winnipeg, MB, Canada

    E. J. Bow M.D.

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  1. School of Medicine, University of Maryland, S. Greene St. 22, Baltimore, 21201, U.S.A.

    Michael Kleinberg

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Bow, E.J. (2009). Prophylaxis. In: Kleinberg, M. (eds) Managing Infections in Patients With Hematological Malignancies. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-415-5_10

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