Simon A, Fleischhack G, Marklein G, Ritter J
Abtl. für pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde des Universitätsklinikums Bonn, Germany.
Klin Padiatr. 2001 Sep;213 Suppl 1:A22-37. doi: 10.1055/s-2001-17500.
Bacterial infections are still a major challenge in the treatment of pediatric cancer patients. Considering the evidence in the literature and published consensus opinions of experts the following strategies of antibacterial chemoprophylaxis (ABCP) in pediatric cancer patients can be recommended (or not recommended): Accompanying the implantation of a ventriculoperitoneal shunt (or a Rickham-reservoir) ABCP is recommended, until prospective controlled studies including pediatric cancer patients have investigated this issue. In bone marrow or stem cell transplant recipients, the prophylactic administration of penicillin should be considered, if severe oral mucositis is a common adverse event in cancer departments with high rates of penicillin-susceptible strains of Streptococcus viridans. Prospective surveillance of resistant bacterial pathogens should be an indispensable tool of quality control in pediatric oncology departments. The risk of infection with antimicrobial-resistant isolates should be balanced against the real benefit of antimicrobial prophylaxis in every instance. ABCP should neither be given during implantation nor during prolonged usage to prevent bacterial infection of a central venous access device (unproven efficacy and potential hazards of Vancomycin-resistant gram-positive infections). The oral administration of non-absorbable ABCP or Trimetoprim-Sufomethoxazole is not recommended for the prevention of bacterial infections (unproven efficacy) and no recommendation can be given for the oral ABCP with chinolones (lacking data, risk of antimicrobial resistance).
细菌感染仍是儿童癌症患者治疗中的一项重大挑战。考虑到文献中的证据以及专家发表的共识意见，对于儿童癌症患者抗菌化学预防（ABCP）的以下策略可予以推荐（或不推荐）：在植入脑室腹腔分流管（或里克姆贮液器）时，推荐进行ABCP，直至包括儿童癌症患者在内的前瞻性对照研究对该问题进行调查。在骨髓或干细胞移植受者中，如果严重口腔黏膜炎是癌症科室中常见的不良事件，且草绿色链球菌对青霉素敏感菌株的发生率较高，则应考虑预防性使用青霉素。对耐药细菌病原体进行前瞻性监测应成为儿科肿瘤科室质量控制中不可或缺的工具。在每种情况下，都应权衡抗菌药物耐药菌株感染的风险与抗菌预防的实际益处。在植入中央静脉通路装置期间或长期使用期间，均不应给予ABCP以预防细菌感染（万古霉素耐药革兰氏阳性菌感染的疗效未经证实且存在潜在危害）。不推荐口服不可吸收的ABCP或甲氧苄啶 - 磺胺甲恶唑来预防细菌感染（疗效未经证实），对于含喹诺酮类的口服ABCP也无法给出推荐意见（缺乏数据，存在抗菌药物耐药风险）。
