tailieunhanh - Chapter 082. Infections in Patients with Cancer (Part 6)

More common than tunnel infections are exit-site infections, often with erythema around the area where the line penetrates the skin. Most authorities (Chap. 129) recommend treatment (usually with vancomycin) for an exit-site infection caused by a coagulase-negative Staphylococcus. Treatment of coagulasepositive staphylococcal infection is associated with a poorer outcome, and it is advisable to remove the catheter if possible. Similarly, many clinicians remove catheters associated with infections due to P. aeruginosa and Candida species, since such infections are difficult to treat and bloodstream infections with these organisms are likely to be deadly. Catheter infections caused by Burkholderia cepacia, Stenotrophomonas. | Chapter 082. Infections in Patients with Cancer Part 6 More common than tunnel infections are exit-site infections often with erythema around the area where the line penetrates the skin. Most authorities Chap. 129 recommend treatment usually with vancomycin for an exit-site infection caused by a coagulase-negative Staphylococcus. Treatment of coagulasepositive staphylococcal infection is associated with a poorer outcome and it is advisable to remove the catheter if possible. Similarly many clinicians remove catheters associated with infections due to P. aeruginosa and Candida species since such infections are difficult to treat and bloodstream infections with these organisms are likely to be deadly. Catheter infections caused by Burkholderia cepacia Stenotrophomonas spp. Agrobacterium spp. and Acinetobacter baumannii as well as Pseudomonas spp. other than aeruginosa are likely to be very difficult to eradicate with antibiotics alone. Similarly isolation of Bacillus Corynebacterium and Mycobacterium spp. should prompt removal of the catheter. Gastrointestinal Tract-Specific Syndromes Upper Gastrointestinal Tract Disease Infections of the Mouth The oral cavity is rich in aerobic and anaerobic bacteria Chap. 157 that normally live in a commensal relationship with the host. The antimetabolic effects of chemotherapy cause a breakdown of host defenses leading to ulceration of the mouth and the potential for invasion by resident bacteria. Mouth ulcerations afflict most patients receiving chemotherapy and have been associated with viridans streptococcal bacteremia. The use of keratinocyte growth factor palifermin in a daily dose of 60 pg kg for 3 days before chemotherapy and total-body irradiation is of proven value in preventing mucosal ulceration after stem cell transplantation. Fluconazole is clearly effective in the treatment of both local infections thrush and systemic infections esophagitis due to Candida albicans. Newer azoles such as voriconazole are similarly .