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Infections in Cancer

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Book cover Management of Infections in the Immunocompromised Host

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Infections are an important cause of morbidity and mortality in the oncology population. Individual’s risk of various infections is dependent on a multitude factors, particularly the type of cancer, sites involved, treatment regimen, procedures, and neutropenia. Preexisting comorbidities such as obesity, diabetes, and lung, kidney, and liver disease are also important factors to take into consideration, as are age, malnutrition, and deconditioning. Neutropenia remains the most important risk factor, with increased depth and duration associated with higher incidence of infection. In this chapter, we will be discussing infections in patients with solid tumors and hematologic malignancies, with the exception of hematopoietic stem cell transplant (HSCT) recipients, as this population will be discussed in a separate chapter.

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References

  1. Kuderer NM, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258–66.

    Article  PubMed  Google Scholar 

  2. Bodey GP, et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64(2):328–40.

    Article  CAS  PubMed  Google Scholar 

  3. Nesher L, Rolston KV. The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection. 2014;42(1):5–13.

    Article  CAS  PubMed  Google Scholar 

  4. Freifeld AG, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56–93.

    Article  PubMed  Google Scholar 

  5. van der Velden WJ, et al. Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis. Br J Haematol. 2014;167(4):441–52.

    Article  PubMed  Google Scholar 

  6. Epstein JB, et al. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin. 2012;62(6):400–22.

    Article  PubMed  Google Scholar 

  7. Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228–37.

    Article  PubMed  Google Scholar 

  8. Crawford J, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Cancer Netw. 2008;6(2):109–18.

    Article  Google Scholar 

  9. Lyman GH, et al. Predicting individual risk of neutropenic complications in patients receiving cancer chemotherapy. Cancer. 2011;117(9):1917–27.

    Article  PubMed  Google Scholar 

  10. Lyman GH, Lyman CH, Agboola O. Risk models for predicting chemotherapy-induced neutropenia. Oncologist. 2005;10(6):427–37.

    Article  PubMed  Google Scholar 

  11. Paul M, et al. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2006;57(2):176–89.

    Article  CAS  PubMed  Google Scholar 

  12. Schimpff SC. Empiric antibiotic therapy for granulocytopenic cancer patients. Am J Med. 1986;80(5C):13–20.

    PubMed  CAS  Google Scholar 

  13. Freifeld A, et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999;341(5):305–11.

    Article  CAS  PubMed  Google Scholar 

  14. Klastersky J, et al. Bacteraemia in febrile neutropenic cancer patients. Int J Antimicrob Agents. 2007;30(Suppl 1):S51–9.

    Article  CAS  PubMed  Google Scholar 

  15. Schimpff SC. Overview of empiric antibiotic therapy for the febrile neutropenic patient. Rev Infect Dis. 1985;7(Suppl 4):S734–40.

    Article  PubMed  Google Scholar 

  16. Paul M, et al. Anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams. Cochrane Database Syst Rev. 2010;11:CD005197.

    Google Scholar 

  17. Cometta A, et al. Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clin Infect Dis. 2003;37(3):382–9.

    Article  CAS  PubMed  Google Scholar 

  18. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group. J Infect Dis. 1991;163(5):951–8.

    Google Scholar 

  19. de Naurois J, et al. Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol. 2010;21(Suppl 5):v252–6.

    Article  PubMed  Google Scholar 

  20. Bucaneve G, et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med. 2005;353(10):977–87.

    Article  CAS  PubMed  Google Scholar 

  21. Baden LR, et al. Prevention and treatment of cancer-related infections. J Natl Compr Cancer Netw. 2012;10(11):1412–45.

    Article  CAS  Google Scholar 

  22. Rangaraj G, et al. Perils of quinolone exposure in cancer patients: breakthrough bacteremia with multidrug-resistant organisms. Cancer. 2010;116(4):967–73.

    Article  PubMed  Google Scholar 

  23. Trecarichi EM, Tumbarello M. Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis. 2014;27(2):200–10.

    Article  CAS  PubMed  Google Scholar 

  24. Nguyen AD, et al. A single-center evaluation of the risk for colonization or bacteremia with piperacillin-tazobactam- and cefepime-resistant bacteria in patients with acute leukemia receiving fluoroquinolone prophylaxis. J Oncol Pharm Pract. 2016;22(2):303–7.

    Article  CAS  PubMed  Google Scholar 

  25. Garnica M, et al. Ciprofloxacin prophylaxis in high risk neutropenic patients: effects on outcomes, antimicrobial therapy and resistance. BMC Infect Dis. 2013;13:356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bow EJ. Fluoroquinolones, antimicrobial resistance and neutropenic cancer patients. Curr Opin Infect Dis. 2011;24(6):545–53.

    Article  CAS  PubMed  Google Scholar 

  27. Wojenski DJ, et al. Cefpodoxime for antimicrobial prophylaxis in neutropenia: a retrospective case series. Clin Ther. 2014;36(6):976–81.

    Article  CAS  PubMed  Google Scholar 

  28. Klastersky J, et al. The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18(16):3038–51.

    Article  CAS  PubMed  Google Scholar 

  29. Baskaran ND, Gan GG, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol. 2008;87(7):563–9.

    Article  PubMed  Google Scholar 

  30. Innes H, et al. Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support Care Cancer. 2008;16(5):485–91.

    Article  PubMed  Google Scholar 

  31. Uys A, Rapoport BL, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer. 2004;12(8):555–60.

    Article  PubMed  Google Scholar 

  32. Kern WV, et al. Oral antibiotics for fever in low-risk neutropenic patients with cancer: a double-blind, randomized, multicenter trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy – EORTC infectious diseases group trial XV. J Clin Oncol. 2013;31(9):1149–56.

    Article  CAS  PubMed  Google Scholar 

  33. Flowers CR, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31(6):794–810.

    Article  PubMed  Google Scholar 

  34. Bodey GP, et al. Fever and infection in leukemic patients: a study of 494 consecutive patients. Cancer. 1978;41(4):1610–22.

    Article  CAS  PubMed  Google Scholar 

  35. Ortega M, et al. Epidemiology and outcome of bacteraemia in neutropenic patients in a single institution from 1991–2012. Epidemiol Infect. 2015;143(4):734–40.

    Article  CAS  PubMed  Google Scholar 

  36. Han SB, et al. Clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia in children with febrile neutropenia. Infection. 2013;41(5):917–24.

    Article  CAS  PubMed  Google Scholar 

  37. Han SB, et al. Clinical characteristics and antimicrobial susceptibilities of viridans streptococcal bacteremia during febrile neutropenia in patients with hematologic malignancies: a comparison between adults and children. BMC Infect Dis. 2013;13:273.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Freifeld AG, Razonable RR. Viridans group streptococci in febrile neutropenic cancer patients: what should we fear? Clin Infect Dis. 2014;59(2):231–3.

    Article  PubMed  Google Scholar 

  39. Shelburne SA 3rd, et al. Development and validation of a clinical model to predict the presence of beta-lactam resistance in viridans group streptococci causing bacteremia in neutropenic cancer patients. Clin Infect Dis. 2014;59(2):223–30.

    Article  CAS  PubMed  Google Scholar 

  40. Marron A, et al. High rates of resistance to cephalosporins among viridans-group streptococci causing bacteraemia in neutropenic cancer patients. J Antimicrob Chemother. 2001;47(1):87–91.

    Article  CAS  PubMed  Google Scholar 

  41. Ford CD, et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol. 2015;36(1):47–53.

    Article  Google Scholar 

  42. Vigil KJ, et al. Multidrug-resistant Escherichia coli bacteremia in cancer patients. Am J Infect Control. 2009;37(9):741–5.

    Article  PubMed  Google Scholar 

  43. Gudiol C, et al. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother. 2011;66(3):657–63.

    Article  CAS  PubMed  Google Scholar 

  44. Gudiol C, et al. Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother. 2010;65(2):333–41.

    Article  CAS  PubMed  Google Scholar 

  45. De Rosa FG, et al. Epidemiology of bloodstream infections in patients with acute myeloid leukemia undergoing levofloxacin prophylaxis. BMC Infect Dis. 2013;13:563.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sandherr M, et al. Antiviral prophylaxis in patients with solid tumours and haematological malignancies – update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol. 2015;94(9):1441–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Bergmann OJ, et al. Acyclovir given as prophylaxis against oral ulcers in acute myeloid leukaemia: randomised, double blind, placebo controlled trial. BMJ. 1995;310(6988):1169–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Aoki T, et al. Efficacy of continuous, daily, oral, ultra-low-dose 200 mg acyclovir to prevent herpes zoster events among bortezomib-treated patients: a report from retrospective study. Jpn J Clin Oncol. 2011;41(7):876–81.

    Article  PubMed  Google Scholar 

  49. Pollyea DA, Brown JM, Horning SJ. Utility of influenza vaccination for oncology patients. J Clin Oncol. 2010;28(14):2481–90.

    Article  PubMed  Google Scholar 

  50. Safdar A, et al. Dose-related safety and immunogenicity of baculovirus-expressed trivalent influenza vaccine: a double-blind, controlled trial in adult patients with non-Hodgkin B cell lymphoma. J Infect Dis. 2006;194(10):1394–7.

    Article  CAS  PubMed  Google Scholar 

  51. Takaoka K, et al. A novel scoring system to predict the incidence of invasive fungal disease in salvage chemotherapies for malignant lymphoma. Ann Hematol. 2014;93(10):1637–44.

    Article  CAS  PubMed  Google Scholar 

  52. Vehreschild JJ, et al. A double-blind trial on prophylactic voriconazole (VRC) or placebo during induction chemotherapy for acute myelogenous leukaemia (AML). J Infect. 2007;55(5):445–9.

    Article  PubMed  Google Scholar 

  53. Rotstein C, et al. Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. The Canadian Fluconazole Prophylaxis Study Group. Clin Infect Dis. 1999;28(2):331–40.

    Article  CAS  PubMed  Google Scholar 

  54. Cornely OA, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356(4):348–59.

    Article  CAS  PubMed  Google Scholar 

  55. Barreto JN, et al. The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole. Am J Hematol. 2013;88(4):283–8.

    Article  CAS  PubMed  Google Scholar 

  56. De Pauw B, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813–21.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42(10):1417–27.

    Article  CAS  PubMed  Google Scholar 

  58. Koo S, et al. Diagnostic performance of the (1-->3)-beta-D-glucan assay for invasive fungal disease. Clin Infect Dis. 2009;49(11):1650–9.

    Article  CAS  PubMed  Google Scholar 

  59. Marty FM, et al. (1->3) beta-D-glucan assay positivity in patients with Pneumocystis (carinii) jiroveci pneumonia. Ann Intern Med. 2007;147(1):70–2.

    Article  PubMed  Google Scholar 

  60. Karageorgopoulos DE, et al. Beta-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011;52(6):750–70.

    Article  CAS  PubMed  Google Scholar 

  61. Fung M, et al. Meta-analysis and cost comparison of empirical versus pre-emptive antifungal strategies in hematologic malignancy patients with high-risk febrile neutropenia. PLoS One. 2015;10(11):e0140930.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Wingard JR, et al. Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation. Blood. 2010;116(24):5111–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Maschmeyer G, et al. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol. 2015;26(1):21–33.

    Article  CAS  PubMed  Google Scholar 

  64. Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med. 2005;142(6):451–66.

    Article  PubMed  Google Scholar 

  65. Bow EJ, Meddings JB. Intestinal mucosal dysfunction and infection during remission-induction therapy for acute myeloid leukaemia. Leukemia. 2006;20(12):2087–92.

    Article  CAS  PubMed  Google Scholar 

  66. Nesher L, Rolston KV. Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2013;56(5):711–7.

    Article  PubMed  Google Scholar 

  67. Gomez L, Martino R, Rolston KV. Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis. 1998;27(4):695–9.

    Article  CAS  PubMed  Google Scholar 

  68. Aksoy DY, et al. Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol. 2007;18(1):183–9.

    Article  CAS  PubMed  Google Scholar 

  69. Dohner H, Weisdorf DJ, Bloomfield CD. Acute myeloid leukemia. N Engl J Med. 2015;373(12):1136–52.

    Article  CAS  PubMed  Google Scholar 

  70. Faderl S, et al. The biology of chronic myeloid leukemia. N Engl J Med. 1999;341(3):164–72.

    Article  CAS  Google Scholar 

  71. Woll PS, et al. Myelodysplastic syndromes are propagated by rare and distinct human cancer stem cells in vivo. Cancer Cell. 2014;25(6):794–808.

    Article  CAS  PubMed  Google Scholar 

  72. Pang WW, et al. Hematopoietic stem cell and progenitor cell mechanisms in myelodysplastic syndromes. Proc Natl Acad Sci U S A. 2013;110(8):3011–6.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Papaemmanuil E, et al. Clinical and biological implications of driver mutations in myelodysplastic syndromes. Blood. 2013;122(22):3616–27. quiz 3699

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Ravandi F, O'Brien S. Immune defects in patients with chronic lymphocytic leukemia. Cancer Immunol Immunother. 2006;55(2):197–209.

    Article  PubMed  Google Scholar 

  75. Freeman JA, et al. Immunoglobulin G subclass deficiency and infection risk in 150 patients with chronic lymphocytic leukemia. Leuk Lymphoma. 2013;54(1):99–104.

    Article  CAS  PubMed  Google Scholar 

  76. Hamblin AD, Hamblin TJ. The immunodeficiency of chronic lymphocytic leukaemia. Br Med Bull. 2008;87:49–62.

    Article  CAS  PubMed  Google Scholar 

  77. Abkur TM, et al. Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol. Clin Case Rep. 2015;3(4):255–9.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Morrison VA. Infectious complications in patients with chronic lymphocytic leukemia: pathogenesis, spectrum of infection, and approaches to prophylaxis. Clin Lymphoma Myeloma. 2009;9(5):365–70.

    Article  CAS  PubMed  Google Scholar 

  79. Morrison VA. Management of infectious complications in patients with chronic lymphocytic leukemia. Hematol Am Soc Hematol Educ Program. 2007:332–8.

    Article  Google Scholar 

  80. Nucci M, Anaissie E. Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents. Clin Infect Dis. 2009;49(8):1211–25.

    Article  CAS  PubMed  Google Scholar 

  81. Costa DB, Shin B, Cooper DL. Pneumococcemia as the presenting feature of multiple myeloma. Am J Hematol. 2004;77(3):277–81.

    Article  PubMed  Google Scholar 

  82. Lanini S, et al. Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis. BMC Med. 2011;9:36.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Martin SI, et al. Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis. 2006;43(1):16–24.

    Article  CAS  PubMed  Google Scholar 

  84. Scappaticci FA, et al. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol. 2005;91(3):173–80.

    Article  CAS  PubMed  Google Scholar 

  85. Eveno C, et al. Bevacizumab doubles the early postoperative complication rate after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2014;21(6):1792–800.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA

    Andrea J. Zimmer & Alison G. Freifeld

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  1. Andrea J. Zimmer
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Correspondence to Andrea J. Zimmer .

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  1. Departments of Medicine and Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA

    Brahm H. Segal

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Zimmer, A.J., Freifeld, A.G. (2018). Infections in Cancer. In: Segal, B. (eds) Management of Infections in the Immunocompromised Host. Springer, Cham. https://doi.org/10.1007/978-3-319-77674-3_10

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