Prevention and treatment of cancer-related infections

Previous NCCN guidelines related to infectious complications of cancer were primarily focused on fever and neutropenia. However, the guidelines were revised in 2007 to address prevention and treatment of infections in neutropenic and non-neutropenic immunocompromised patients with cancer. These NCCN guidelines on "Prevention and Treatment of Cancer-Related Infections" replace the previous guidelines on "Fever and Neutropenia." Substantial progress has been made in preventing and treating infectious complications of neutropenia and immunosuppressive therapy in patients with cancer. It is essential to know the patient's quantitative and qualitative immune defects and to stratify the risk for specific pathogens in the context of the history, physical examination, radiologic, and laboratory data. The development of antipseudomonal β-lactam agents and the routine use of empiric antibacterial therapy at the onset of neutropenic fever reduced mortality from bacterial infections.³⁰² More patients were treated with potent cytotoxic regimens (e.g., for acute leukemia) and received allogeneic stem cell transplants; opportunistic viral and fungal infections became an important cause of mortality in these patients. In addition, the increasing prevalence of antibiotic-resistant pathogens has challenged the clinician to use antimicrobial therapy wisely. Infection control should not rely exclusively on antimicrobial prophylaxis, but rather should continue to incorporate standard infection control measures and demand careful hand-washing by all health care professionals who come into contact with immunocompromised patients.