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Fieber und Neutropenie nach Chemotherapie

Fever and neutropenia after chemotherapy

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Zusammenfassung

Hintergrund

Fieber bei Neutropenie nach Chemotherapie (FN) ist eine der häufigsten therapieassoziierten Komplikationen im kinderonkologischen Patientenkollektiv. Der Befund ist zumindest in einem Teil der Fälle Ausdruck einer bakteriellen Infektion und stellt einen onkologischen Notfall dar. Deshalb ist ein schnelles medizinisches Management essenziell.

Diagnose

In der Diagnostik sind die Identifikation des Hochrisikopatienten anhand anamnestischer und klinischer Parameter und die Initiierung mikrobiologischer Diagnostik von großer Bedeutung. Ein eindeutiger Organbefund im Sinne eines infektiösen Fokus kann nur selten erhoben werden. Die normalerweise relevanten Inflammationsparameter [CRP (C-reaktives Protein), Prokalzitonin usw.] spielen für die Diagnostik und Therapieentscheidung allenfalls eine nachgeordnete Rolle.

Behandlung

Eine empirische antibiotische Therapie ist unverzüglich einzuleiten. Dabei ist zu berücksichtigen, dass nicht selten auch fungale und virale Erreger Ursache einer Infektion bei Neutropenie sein können. Dies muss bei klinischer Verschlechterung und einer notwendigen Adaptation des initialen antiinfektiösen Therapieregimes berücksichtigt werden.

Resümee

Es wird eine Übersicht über mögliche Strategien zur Diagnostik und Therapie von FN anhand aktueller internationaler Leitlinien gegeben.

Abstract

Background

Fever and neutropenia after chemotherapy (FN) is one of the most common therapy-associated complications in children with cancer. This potentially life-threatening event is partially due to bacterial infections. A standardized and quick work-up is essential.

Diagnosis

The identification of a high-risk patient with regard to anamnestic and clinical parameters as well as the detection of the underlying pathogen is crucial. A defined site of infection is rarely revealed. Common inflammatory parameters as C-reactive protein and procalcitonin are not considered significantly helpful in the decision-making process of antibiotic use.

Treatment

Antibiotic therapy has to be initiated immediately. In concern of resistant bacterial and fungal and viral pathogens, respectively, therapy modification should be based on clinical and microbiologic factors.

Conclusion

In this article, diagnostic and therapeutic procedures are reviewed.

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Danksagung

Wir danken Herrn Univ.-Prof. Dr. Thomas Lehrnbecher als Vetreter der Arbeitsgemeinschaft Fieber und Neutropenie der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) für die hilfreichen Ergänzungen, Kommentare und Anmerkungen.

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Authors and Affiliations

  1. Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    A. Wingerter, J. Dudda &  J. Faber

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  1. A. Wingerter
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  2. J. Dudda
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  3. J. Faber
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Correspondence to J. Faber.

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Wingerter, A., Dudda, J. & Faber, J. Fieber und Neutropenie nach Chemotherapie. Monatsschr Kinderheilkd 161, 211–216 (2013). https://doi.org/10.1007/s00112-012-2781-7

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