Infections in Immunosuppressed and Cancer Patients - Related Resources

Cochrane reviews

Children appear to be less likely to develop nephrotoxicity with a lipid preparation of amphotericin B compared with conventional amphotericin B used for proven, probable or suspected invasive fungal infections Antifungal Therapy in Infants and Children with Invasive Fungal Infections.
Oral antibiotics are an acceptable alternative to intravenous antibiotics for treating febrile neutropenia in cancer patients at low risk for complications Oral Versus Intravenous Antibiotic Treatment for Febrile Neutropenia in Cancer Patients.
Prophylactic therapy with intravenous amphotericin B may improve prognosis in patients with cancer and neutropenia Routine Versus Selective Antifungal Administration for Control of Fungal Infections in Patients with Cancer.
Empirical anti-Gram-positive antibiotic treatment with glycopeptides (vancomycin, teicoplanin) appears not to improve outcomes in febrile neutropenic cancer patients Empirical Anti-Gram-Positive Antibiotic Treatment for Febrile Neutropenic Cancer Patients.
Antifungal primary prophylaxis with either itraconazole or fluconazole is effective in reducing the incidence of cryptococcal disease in adults with advanced HIV disease Antifungal Prophylaxis for Cryptococcal Disease in Adults with HIV.
Pre-emptive treatment with antiviral agents for solid organ transplant recipients reduces the risk of cytomegalovirus disease when compared to placebo or standard care. The outcomes are similar to routine prophylactic antiviral therapy Pre-Emptive Antiviral Treatment to Prevent Cytomegalovirus Disease in Solid Organ Transplant Recipients.
Evidence is inconclusive to support or refute generalised use of granulocyte transfusions to treat infections in patients with neutropenia caused by chemotherapy Granulocyte Transfusions for Treating Infections in Neutropenic Patients.
Intravenous amphotericin B has documented effect on mortality in cancer patients with neutropenia. There is not sufficient evidence to judge the relative merits of other antifungal agents Routine Versus Selective Antifungal Administration for Control of Fungal Infections in Patients with Cancer.
Ketoconazole may be effective in eradicating oral candidiasis in patients with cancer receiving either chemotherapy or radiotherapy treatment. For clotrimazole, 50 mg dose appears to be more effective than 10 mg dose Treating Oral Candidiasis in Cancer Patients.
Prophylactic use of trimethoprim/sulfamethoxazole decreases the occurrence of Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. PCP-related mortality also appears to decrease Prophylaxis for Pneumocystis Pneumonia in Non-HIV Immunocompromised Patients.
Flushing the central venous catheter with a combination of vancomycin and heparin appears to reduce the rate of Gram-positive catheter-related infections in oncology patients Prophylactic Antibiotics for Preventing Central Venous Catheter Infections in Oncology Patients.
Prophylactic granulocyte transfusions at a dose of at least 1 x 10¹⁰ seem to be effective in reducing the risk of mortality from infection in patients with neutropenia or neutrophil dysfunction, but there is insufficient evidence from adequate trials Granulocyte Transfusions for Preventing Infections in Patients with Neutropenia or Neutrophil Dysfunction.
Antibiotic prophylaxis reduces all-cause mortality in afebrile neutropenic patients following chemotherapy. The evidence is strongest for quinolones. The addition of gram-positive prophylaxis reduces the incidence of gram-positive bacteraemia Antibiotic Prophylaxis for Neutropenic Patients.

Other evidence summaries

Imipenem-cilastatin may be more effective than beta-lactam based regimens for empirically treating febrile neutropenic patients Imipenem-Cilastatin for Febrile Neutropenic Patients.

Literature

Centers for Disease Control and Prevention, Infectious Disease Society of America, American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000 Oct;49(RR-10):1-125, CE1-7. [PubMed]
Slavin MA, Osborne B, Adams R, Levenstein MJ, Schoch HG, Feldman AR, Meyers JD, Bowden RA. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation--a prospective, randomized, double-blind study. J Infect Dis 1995 Jun;171(6):1545-52. [PubMed]
Dykewicz CA, Centers for Disease Control and Prevention (U.S.), Infectious Diseases Society of America, American Society of Blood and Marrow Transplantation. Summary of the Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem Cell Transplant Recipients. Clin Infect Dis 2001 Jul 15;33(2):139-44. [PubMed]
Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, Shadduck RK, Shea TC, Stiff P, Friedman DJ. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992 Mar 26;326(13):845-51. [PubMed]

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References

Infections in Immunosuppressed and Cancer Patients - Related Resources

Cochrane reviews

Other evidence summaries

Literature