Introduction
Compliance with Ethics Guidelines
Risk Factors for Infection
Risk factor(s)a
| Additional explanatory comments |
---|---|
Neutropenia | Chemotherapy, radiation therapy, bone marrow infiltration with tumor, drugs (e.g., ganciclovir) |
Disruption of anatomic barriers (e.g., skin, mucosal surfaces) | Chemotherapy (mucositis), radiation therapy, vascular access catheters, urinary catheters, percutaneous endoscopic gastrostomy tubes and other medical devices, surgical/diagnostic procedures |
Obstruction due to primary or metastatic tumor | Airways: post-obstructive pneumonia, lung abscess, empyema, fistula formation (e.g., broncho-pleural or trachea-esophogeal) |
Biliary tract: ascending cholangitis, hepatic and pancreatic abscess | |
Bowel: bowel obstruction, necrosis, perforation, peritonitis, hemorrhage | |
Urinary tract: urinary tract infection, renal abscess, prostatitis or prostatic abscess | |
Procedure and devices | Diagnostic/therapeutic surgery: surgical site infections, wound dehiscence, abscess formation |
Shunts: disseminated infection (bacteremia) shunt-related infections such as meningitis/ventriculitis, hepato-biliary infections, complicated urinary tract infections | |
Prosthetic devices: infected prosthesis, osteomyelitis and/or septic arthritis, local abscess formation, disseminated infection | |
Miscellaneous factors | Age, nutritional status, prior antibiotic exposure, loss of gag reflex |
Neutropenia
Disruption of Anatomic Barriers
Obstruction of Normal Passages
Procedures and Devices
Miscellaneous Factors
Common Sites of Infection
Infection site | Comments |
---|---|
Bloodstream | Often associated with vascular access catheters and neutropenia. Changing epidemiology, with resistant Gram-negative organisms emerging |
Breast | Generally related to breast cancer surgery, including reconstruction and implants. Changing epidemiology with MRSA and Gram-negative organisms common |
Bone, cartilage, joints | Often surgery- or prosthetic device-related. May require device removal and/or long-term suppressive therapy |
Central nervous system | Including ventriculitis, meningitis, shunt-related infections, and post-surgical infections |
Skin and skin structure | Most often related to surgery, including invasive diagnostic procedures. May be chronic or persistent in irradiated areas. Poly-microbial infections are common |
Respiratory tract | Aspiration pneumonia in patients with loss of gag reflex or ciliary function. Post-obstructive pneumonia (with empyema or fistula formation with progressive disease) |
Hepato-biliary pancreatic | Ascending cholangitis (±bacteremia); local abscess formation, reactivation of viral infections (HBV, HCV, CMV) |
Upper gastro-intestinal | Tracheo-esophageal fistula; percutaneous endoscopic gastrostomy (PEG)-tube-related infection, gastric perforation with abscess formation or peritonitis |
Lower gastro-intestinal, pelvic | Bowel perforation with peritonitis or abscess formation, neutropenic enterocolitis, Clostridium difficile- or CMV-associated colitis; perirectal/peri-anal infection |
Genitourinary tract and prostate | Complicated urinary tract infections; obstructive uropathy; prostatitis; abdominal and/or pelvic abscesses |
Current Microbiology of Infection
Specific Syndromes/Sites of Infection
Bloodstream Infections
Post-obstructive Pneumonia
Infections Associated with Breast Cancer Surgery
Hepato-biliary Infection
Infections Involving the Intestinal Tract
Hepatitis
Obstructive Uropathy/Complicated Urinary Tract Infections
Infections Mimicking Cancer
Summary
Clinical syndrome | Comments |
---|---|
Post-obstructive pneumonia | Frequent in patients with primary or metastatic lung lesions. Sometimes the initial manifestation of malignancy. Complications include lung abscess, fistula formation, or empyema. Treatment failures common |
Obstructive uropathy | Common in patients with genitourinary and prostatic tumors. Complicated urinary tract infections and multidrug-resistant organisms are frequent |
Reactivation of viral infections | Hepatitis B virus and hepatitis C virus, usually following chemotherapy or immunosuppressive therapy. Screening for all patients scheduled to receive chemotherapy is recommended as is HBV prophylaxis for patients with HBV infection |
Clostridium difficile associated disease | Multiple risk factors (antibiotics, chemotherapy, local anatomical factors). Recurrent infections/relapses common. Newer therapies (fidaxomicin, fecal microbiota transplantation) have been developed |
Neutropenic enterocolitis | Associated with taxanes (docetaxel and paclitaxel), vinorelbine, and other agents producing severe mucositis |