癌症相关感染预防与治疗课件

癌症相关感染的预防和治疗临床药学科李林癌症相关感染的预防和治疗1内容提要、癌症相关感染的预防二、粒缺合并发热的管理三、特定感染部位的评估和治疗内容提要2口感染相关性癌症口癌症相关性感染法国国际癌症研究机构(IARC)的研究|·指癌症病人在整个病程中受到包括细菌、表明,全球每年约200万例新发癌症病例真菌、病毒及寄生虫等病原体的感染。与感染相关,占每年新发癌症病例的据统计,95%以上感染的病原体是细菌16.1%其中6065%为G菌,主要为肠杆菌科和每年约190万例新发癌症病例与幽门螺杆假单胞菌。菌(Hp)、乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和人乳头状瘤病毒粒细胞缺乏导致的感染,它是癌症的常见(HPV)感染相关,主要为胃癌、肝癌和并发症,也是癌症病人死亡的常见原因。子宫颈癌欠发达国家的感染相关癌症是发达国家的3syntheticanalysis,LancetOncol,2019,13(6):p607-615areviewandGlobalburdenofcancersattributabletoinfectionsin2019口感染相关性癌症3易感因素口与原发性癌症相关的免疫缺陷CLL、ALL、NHL、MDS、MM实体瘤(坏死、手术)癌症进展口中性粒细胞减少(化疗、放疗)2.0*10^9Vs05*10^9口脾脏切除或功能性无脾发热(50-60%)CDC推荐≤55岁疫苗败血症(10-20%、0.1*10^9)口免疫抑制剂的使用口粘膜屏障破坏激素、氟达拉滨、阿伦口腔、胃肠道、泌尿系统单抗口造血干细胞移植易感因素4感染风险因素分级OVERALLINFECTIONDISEASE/THERAPYEXAMPLESFEVER&NEUTROPENIARISKANTIMICROBIALCATEGORYSeeFEV-2WITHCANCERmostsolidtumorAnticipatedneutropenialessthan7dViral-NoneunlesspriorHSVepisodentermediateAutologousHSCTUsuallyHIGH,butsomeexperts.Bacterial-ConsiderfluoroquinoloneMultiplemyelonpendingonpatientstatusConsiderfiuconazoleduring.CLLPurineanalogsintermediatePurineanalogtherapy(ie,fludarabine,riskwhenusedassingleagents;mucositisViral-Duringneutropeniaandatleastipatedneutropenia7to10dchemotherapyregimens,therisk30dafterHSCTconvertstohiglAllogeneicHSCTincludingcordbloodUsuallyHIGH,butsignificant.Bacterial-ConsiderfluoroquinoloneFungal-(SeeINF-2)munosuppressiveagentsral-duringneutropeniaandatleastAlemtuzumabtherapystatusofunderlying30DafterhsctGVHDtreatedwithhighdosesteroidsalignancynticipatedneutropeniagreaterthan10感染风险因素分级5感染风险因素分级RALLINFECTIONDISEASE/THERAPYEXAMPLESANTIFUNGALPROPHYLAXIS,kISKINPATIENTSWITHCANCERAmphotericinBproducts'(category2B)AML(neutropenicAmphotericinBproducts"(category2B)INTERMEDIATEAutologousHSCTwithmucositis'autologousHSCTwithoutmucositisConsidernoprophylaxis(category2B)AllogeneicHSCT(neutropenic)SeeAntipneumocystisProphylaxis(INF-5)-Voriconatleast75dafttransplantSeeAnmocystisProphylaxis(NE-5).Echinocandin(category2B)significantGVHD感染风险因素分级6感染风险因素分级VERALLINFECTIONDISEASE/THERAPYVIRALANTMVIRALMINIMUMDURATIONWITHCANCERStandardchemotherapyNoneunlesspriorDuringactivetherapyincludingperiodsofgimensforsolidtumorsHSVepisodetermediateuringactivetherapyandatleast30dafderVZVprophylaxisforatleastMultipleMyelomavalacyclovir1yafterHSCTanalogtherapy(ie,fluduringactivetherapyincludingperiodsofProteasomeinhibitorsVZVDuringactivetherapyincludingporiodsvalacyclovirvZVacyclovirprophylaxisshouldbeopeniaandatseeINF-4)forCMMPre-emptivetherapyforCMV(SeeINF-41(SoeINF.5)forHBvIAntiviraltherapyforHBVISnnNE-5感染风险因素分级7、癌症相关感染的预防、癌症相关感染的预防8癌症相关感染的预防口粒缺期间预防性抗生素治疗口肺炎链球菌感染预防口预防性抗真菌治疗口抗病毒预防用药与抢先抗病毒治疗口卡氏肺孢子虫病预防癌症相关感染的预防9粒缺期间预防性抗生素治疗是否需要预防性抗生素?何种抗生素是最好的选择?预防用药会否增加细菌耐药?哪些情况需要预防用药?粒缺期间预防性抗生素治疗10癌症相关感染预防与治疗课件11癌症相关感染预防与治疗课件12癌症相关感染预防与治疗课件13癌症相关感染预防与治疗课件14癌症相关感染预防与治疗课件15癌症相关感染预防与治疗课件16癌症相关感染预防与治疗课件17癌症相关感染预防与治疗课件18癌症相关感染预防与治疗课件19癌症相关感染预防与治疗课件20癌症相关感染预防与治疗课件21癌症相关感染预防与治疗课件22癌症相关感染预防与治疗课件23癌症相关感染预防与治疗课件24癌症相关感染预防与治疗课件25癌症相关感染预防与治疗课件26癌症相关感染预防与治疗课件27癌症相关感染预防与治疗课件28癌症相关感染预防与治疗课件29癌症相关感染预防与治疗课件30癌症相关感染预防与治疗课件31癌症相关感染预防与治疗课件32癌症相关感染预防与治疗课件33癌症相关感染预防与治疗课件34癌症相关感染预防与治疗课件35癌症相关感染预防与治疗课件36癌症相关感染预防与治疗课件37癌症相关感染预防与治疗课件38癌症相关感染预防与治疗课件39癌症相关感染预防与治疗课件40癌症相关感染预防与治疗课件41癌症相关感染预防与治疗课件42癌症相关感染预防与治疗课件43癌症相关感染预防与治疗课件44癌症相关感染预防与治疗课件45癌症相关感染预防与治疗课件46癌症相关感染预防与治疗课件47癌症相关感染预防与治疗课件48癌症相关感染预防与治疗课件49癌症相关感染预防与治疗课件50癌症相关感染预防与治疗课件51癌症相关感染预