癌症相关感染预防与治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,3,synthetic analysis, Lancet Oncol, 2019, 13(6): p607-615 a review and,Global burden of cancers attributable to infections in 2019,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*109Vs05*109,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*109)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,OVERALL INFECTION DISEASE/ THERAPY EXAMPLES,FEVER&NEUTROPENIA RISKANTIMICROBIAL,CATEGORY See FEV-2,WITH CANCER,most solid tumor,Anticipated neutropenia less than 7d,Viral-None unless prior HSV episode,ntermediate,Autologous HSCT,Usually HIGH, but some experts.Bacterial-Consider fluoroquinolone,Multiple myelon,pending on patient status,Consider fiuconazole during,. CLL,Purine analogs intermediate,Purine analog therapy (ie, fludarabine, risk when used as single agents;mucositis,Viral-During neutropenia and at least,ipated neutropenia 7 to 10 d,chemotherapy regimens, the risk 30 d after HSCT,converts to higl,Allogeneic HSCT including cord blood Usually HIGH, but significant .Bacterial-Consider fluoroquinolone,Fungal-(See INF-2),munosuppressive agents,ral-during neutropenia and at least,Alemtuzumab therapy,status of underlying,30 D after hsct,GVHD treated with high dose steroids,alignancy,nticipated neutropenia greater than 10,感染风险因素分级,5,感染风险因素分级,RALL INFECTION DISEASE/ THERAPY EXAMPLES,ANTIFUNGAL PROPHYLAXIS, k,ISK IN PATIENTS,WITH CANCER,Amphotericin B products (category 2B),AML (neutropenic,Amphotericin B products(category 2B),INTERMEDIATE,Autologous HSCT with mucositis,autologous HSCT without mucositis,Consider no prophylaxis(category 2B),Allogeneic HSCT (neutropenic),See Antipneumocystis Prophylaxis (INF-5)-Voricon,at least 75 d aft,transplant,See An,mocystis Prophylaxis (NE-5). Echinocandin(category 2B),significant GVHD,感染风险因素分级,6,感染风险因素分级,VERALL INFECTION DISEASE/THERAPY,VIRAL,ANTMVIRAL,MINIMUM DURATION,WITH CANCER,Standard chemotherapy,None unless prior During active therapy including periods of,gimens for solid tumors,HSV episod e,termediate,uring active therapy and at least 30 d af,der VZV prophylaxis for at least,Multiple Myeloma,valacyclovir,1 y after HSCT,analog therapy,(ie, flud,uring active therapy including periods of,Proteasome inhibitors,VZV,During active therapy including poriods,valacyclovir,vZV,acyclovir prophylaxis should be,openia and at,seeINF-4)for CMM Pre-emptive therapy for CMV(See INF-41,(Soe INF.5) for HBvIAntiviral therapy for HBVISnn NE-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,癌症相关感染预防与治疗课件,52,癌症相关感染预防与治疗课件,53,癌症相关感染预防与治疗课件,54,癌症相关感染预防与治疗课件,55,癌症相关感染预防与治疗课件,56,癌症相关感染预防与治疗课件,57,癌症相关感染预防与治疗课件,58,癌症相关感染预防与治疗课件,59,癌症相关感染预防与治疗课件,60,癌症相关感染预防与治疗课件,61,癌症相关感染预防与治疗课件,62,癌症相关感染预防与治疗课件,63,