Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO)

Annika Y Classen,Florian Weißinger,Marie Von Lilienfeld-Toal,Stefan W Krause,Olaf Penack,Jörg Janne Vehreschild,Georg Maschmeyer,Luisa Durán Graeff,Oliver A Cornely,Karin Mayer,Larissa Henze,Silke Neumann,Maximilian Christopeit,Hans-Heinrich Wolf,Michael Sandherr,Nael Alakel

doi:10.1007/s00277-021-04452-9

Abstract

Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.

Highlights

During recent years, the advent of an increasing amount of targeted drugs and other strategies of personalized medicine has resulted in rapid changes in treatment paradigms for hematologic and oncologic patients
We updated our guideline to give an overview about current evidence on antibacterial prophylaxis strategies and the choice of drugs to prevent bacterial infection and Pneumocystis jirovecii pneumonia (PcP) in neutropenic patients
Recommendations have been approved via expert consensus during the AGIHO plenary meeting on 13 March 2017 and the manuscript was reviewed by all co-authors prior to submission

Summary

Introduction

The advent of an increasing amount of targeted drugs and other strategies of personalized medicine has resulted in rapid changes in treatment paradigms for hematologic and oncologic patients. We updated our guideline to give an overview about current evidence on antibacterial prophylaxis strategies and the choice of drugs to prevent bacterial infection and PcP in neutropenic patients.

Results

Conclusion