Purpose & Patient Population
PURPOSE: To provide guidance for the clinical practice of preventing and treating infection in patients with cancer
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Evidence-based guideline
DATABASES USED: PubMed 2013–2015 for update from prior guideline
INCLUSION CRITERIA: English language, clinical trials, guidelines, systematic review, meta-analysis
Phase of Care and Clinical Applications
PHASE OF CARE: Multiple phases of care
Results Provided in the Reference
One thousand one hundred sixty-two publications were retrieved. No method of study quality evaluation or results were reported.
Guidelines & Recommendations
Recommendations include considerations of general antibacterial prophylaxis in patients at intermediate and high risk for infection, considerations of antifungal prophylaxis during neutropenia and for anticipated mucositis, and antiviral prophylaxis with intermediate and high-risk patients. Specific agents are suggested for prophylaxis and treatment in various clinical scenarios. The guidelines outline treatment and diagnostic/assessment approaches for neutropenic fever and specific clinical presentations. They note that chlorhexidine and sliver sulfadiazine-coated short-term central catheters have been shown to decrease the incidence of catheter colonization and bloodstream infections, but not in patients with hematologic malignancies requiring catheters indwelling for about 20 days. The NCCN does not currently endorse the use of a vancomycin lock solution for long-term vascular access devices because of concerns about the emergence of bacterial resistance if widely used. Influenza vaccination with a vaccine that does not have live attenuated organisms can be safely administered, and the guidelines recommend administering the vaccination at least two weeks before a patient receives cytotoxic therapy and annually. Pneumococcal vaccination is recommended in newly diagnosed patients who have not previously received this type of vaccination. HPV vaccination is suggested for patients up to the age of 26. The guidelines provide a recommended vaccination schedule for HVT patients.
Limitations
The combination of evidence- and consensus-based recommendations and the differentiation between them are not clearly stated. For vascular access device prevention of infection, the guidelines only address antimicrobial-coated catheters and not any other aspect of management.
Nursing Implications
The guidelines provide a comprehensive reference to assess patient risk of infection and expert recommendations regarding interventions aimed at the prevention and treatment of infection in patients with cancer. They do not discuss long-term survivorship issues in this area.
