Evaluation and management of bacterial and fungal infections in patients with a hematological malignancy: A 2018 update

Abstract

Bacterial and fungal infections continue to be an unwelcome complication of the treatment of patients with hematological malignancies despite much progress in the oncologic management in recent years. Some new treatment advances and modalities have offered hope to entire new patient populations, but have also opened the door for opportunistic and invasive organisms. Developments in antimicrobial agents, diagnostic methods, and infection control practices have unfortunately not been able to keep up with rapid developments in oncologic therapies nor antimicrobial resistance. Understanding and control of risk factors for antineoplastic therapy-associated immune-suppression, antimicrobial mechanisms and effects, and changing microbial characteristics are key factors to prevention and treatment of bacterial and fungal infection in this complex patient population. This chapter aims to provide a solid understanding of all these principles and factors to enable educated decision-making, considering guidelines and evidence when these exist, and rational recommendations when evidence is lacking for a particular topic.