Summary
Infection is an important cause of death in patients receiving cytostatic drugs or with any other impairment of host resistance. Such infections are frequently due to opportunist micro-organisms usually belonging to the endogenous flora of the patient. It is often difficult to obtain an exact diagnosis of the cause and localization of the infection. The problems associated with the prevention of infection are manifold. Exogenous infections can be prevented by proper isolation and a sterile diet. Endogenous infections can only be prevented by eradication of the patient's endogeous flora, so-called decontamination. Special attention should be given to treatment of foci of chronic infection and of the carrier state of certain microorganisms. However, the prophylactic use of antibiotics should be avoided. The curative use of antibiotics should be based on the most probable micro-organism. We consider the inventory of the patient's microflora, repeated weekly, of great help in the choice of antibiotics in cases of septicaemia of unknown aetiology. The initial therapy usually consists of a broad-spectrum combination of antibiotics, which should be bactericidal. When the causative bacteria have been isolated and the sensitivity is known, antibiotic therapy should be adjusted to the narrowest spectrum possible.
Zusammenfassung
Die Infektion ist eine wesentliche Todesursache bei Patienten, die unter zytostatischer Medikation stehen oder bei denen irgendeine andere Beeinträchtigung der körpereigenen Widerstandskraft vorliegt. Derartige Infektionen sind häufig auf opportunistisch-pathogene Erreger zurückzuführen, die für gewöhnlich zur endogenen Flora des Patienten gehören. Eine exakte Diagnose der Ursache und Lokalisierung der Infektion ist oft schwierig.
Die mit der Infektionsverhütung einhergehenden Probleme sind vielschichtig. Exogene Infektionen können durch geeignete Isolierung und eine sterile Diät verhindert werden. Endogene Infektionen lassen sich nur durch eine Ausrottung der endogenen Flora des Patienten, d.h. durch „Entseuchung“ verhindern. Besondere Aufmerksamkeit ist der Behandlung chronischer Infektionsherde und dem Trägerstatus bestimmter Mikroorganismen zu widmen. Die prophylaktische Anwendung von Antibiotika sollte jedoch vermieden werden.
Die therapeutische Anwendung von Antibiotika sollte auf die größtmögliche Wahrscheinlichkeit des zugrundeliegenden Erregers ausgerichtet sein. Wir halten die wöchentlich wiederholte Inventur der Mikroflora des Patienten in Fällen von Septikämie unbekannter Ätiologie für eine große Hilfe. Die Anfangsbehandlung besteht für gewöhnlich aus einer Breitbandkombination von Antibiotika, die bakterizid wirken sollte. Sobald die ursächlichen Bakterien isoliert wurden und die Empfindlichkeit bekannt ist, sollte das Spektrum der antibiotischen Therapie soweit wie möglich eingeengt werden.
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Nauta, E., van Furth, R. Infection in immunodepressed patients. Infection 3, 202–208 (1975). https://doi.org/10.1007/BF01642766
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DOI: https://doi.org/10.1007/BF01642766