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Chapter 082. Infections in Patients with Cancer

Infections are a common cause of death and an even more common cause of morbidity in patients with a wide variety of neoplasms. Autopsy studies show that most deaths from acute leukemia and half of deaths from lymphoma are caused directly by infection. With more intensive chemotherapy, patients with solid tumors have also become more likely to die of infection. Fortunately, an evolving approach to prevention and treatment of infectious complications of cancer has decreased rates of infection-associated mortality and will probably continue to do so. . | Chapter 082. Infections in Patients with Cancer Infections are a common cause of death and an even more common cause of morbidity in patients with a wide variety of neoplasms. Autopsy studies show that most deaths from acute leukemia and half of deaths from lymphoma are caused directly by infection. With more intensive chemotherapy patients with solid tumors have also become more likely to die of infection. Fortunately an evolving approach to prevention and treatment of infectious complications of cancer has decreased rates of infection-associated mortality and will probably continue to do so. This accomplishment has resulted from three major steps The concept of quot early empirical quot antibiotics reduced mortality rates among patients with leukemia and bacteremia from 84 in 1965 to 44 in 1972. With better availability and early use of broad-spectrum antibiotics this figure has recently dropped to 20-36 . quot Empirical quot antifungal therapy has lowered the incidence of disseminated fungal infection in trial settings mortality rates now range from 7 to 21 . An antifungal agent is administered on the basis of likely fungal infection to neutropenic patients who after 4-7 days of antibiotic therapy remain febrile but have no positive cultures. Use of antibiotics for afebrile neutropenic patients as broad-spectrum prophylaxis against infections promises to decrease both mortality and morbidity even further. A physical predisposition to infection in patients with cancer Table 82-1 can be a result of the neoplasm s production of a break in the skin. For example a squamous cell carcinoma may cause local invasion of the epidermis which allows bacteria to gain access to the subcutaneous tissue and permits the development of cellulitis. The artificial closing of a normally patent orifice can also predispose to infection Obstruction of a ureter by a tumor can cause urinary tract infection and obstruction of the bile duct can cause cholangitis. Part of the host s normal .