Practice Guideline

. 2021 Jun;100(6):1603-1620.

doi: 10.1007/s00277-021-04452-9. Epub 2021 Apr 13.

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^{1

2}, Larissa Henze³, Marie von Lilienfeld-Toal⁴, Georg Maschmeyer⁵, Michael Sandherr⁶, Luisa Durán Graeff^{1

2}, Nael Alakel⁷, Maximilian Christopeit⁸, Stefan W Krause⁹, Karin Mayer¹⁰, Silke Neumann¹¹, Oliver A Cornely^{1

2

12

13}, Olaf Penack¹⁴, Florian Weißinger¹⁵, Hans-Heinrich Wolf¹⁶, Jörg Janne Vehreschild^{17

18

19}

Affiliations

¹ Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
² German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
³ Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany.
⁴ Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany.
⁵ Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
⁶ Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany.
⁷ Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany.
⁸ Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany.
⁹ Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany.
¹⁰ Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany.
¹¹ Interdisciplinary Center for Oncology, Wolfsburg, Germany.
¹² Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
¹³ University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
¹⁴ Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
¹⁵ Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany.
¹⁶ Department IV of Internal Medicine, University Hospital Halle, Halle, Germany.
¹⁷ Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany. joerg.vehreschild@uk-koeln.de.
¹⁸ German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany. joerg.vehreschild@uk-koeln.de.
¹⁹ Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany. joerg.vehreschild@uk-koeln.de.

PMID: 33846857
PMCID: PMC8116237
DOI: 10.1007/s00277-021-04452-9

Practice Guideline

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 et al. Ann Hematol. 2021 Jun.

. 2021 Jun;100(6):1603-1620.

doi: 10.1007/s00277-021-04452-9. Epub 2021 Apr 13.

Authors

Affiliations

¹ Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
² German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
³ Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany.
⁴ Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany.
⁵ Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
⁶ Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany.
⁷ Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany.
⁸ Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany.
⁹ Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany.
¹⁰ Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany.
¹¹ Interdisciplinary Center for Oncology, Wolfsburg, Germany.
¹² Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
¹³ University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
¹⁴ Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
¹⁵ Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany.
¹⁶ Department IV of Internal Medicine, University Hospital Halle, Halle, Germany.
¹⁷ Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany. joerg.vehreschild@uk-koeln.de.
¹⁸ German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany. joerg.vehreschild@uk-koeln.de.
¹⁹ Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany. joerg.vehreschild@uk-koeln.de.

PMID: 33846857
PMCID: PMC8116237
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.

Keywords: Bacterial infections; Neutropenia; Pneumocystis; Prophylaxis; Resistance.

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Conflict of interest statement

Annika Y. Classen, Larissa Henze, Luisa Durán Graeff, Karin Mayer, Silke Neumann, Stefan Krause, Hans-Heinrich Wolf, and Florian Weißinger declare that they have no conflict of interest.

Marie von Lilienfeld-Toal has received travel grants and honoraria from Celgene, Gilead, Chugai, Janssen, Novartis, Amgen, Takeda, BMS, Medac, Oncopeptides, Merck, CDDF, and Pfizer; is a consultant for Celgene, Gilead, Oncopeptides, MSD, 4DPharma, Janssen, and Shionogi; and received research funding from BMBF, Deutsche Jose Carreras Leukämie-Stiftung, IZKF Jena, DFG, Novartis, Gilead, Deutsche Krebshilfe, Celgene, and Deutsche Forschungsgemeinschaft.

Georg Maschmeyer received honoraria for lectures from Amgen, Gilead, Bristol-Myers Squibb, Merck-Serono, and Janssen-Cilag.

Michael Sandherr received honoraria for lectures from Roche and BMS.

Nael Alakel received honoraria for lectures from Basilea Pharmaceutica and honoraria for advice from Gilead, MSD Sharp & Dohme GmbH, Pfizer, and Amgen.

Maximilian Christopeit reports personal fees from Merck/MSD, GILEAD, Basilea, IQONE, and Shionogi; non-financial support and other from Robert-Koch-Institut during the conduct of the study; other from Celgene, Neovii, and Eurocept; and personal fees from JAZZ, outside the submitted work.

Olaf Penack has received honoraria and travel support from Astellas, Gilead, Jazz, MSD, Neovii Biotech, Pfizer, and Therakos. He has received research support from Bio Rad, Gilead, Incyte, Jazz, Neovii Biotech, Pierre Fabre, Sanofi, and Takeda. He is member of the advisory board to Jazz, Gilead, MSD, Omeros, Shionogi, and SOBI.

Oliver A. Cornely is supported by the German Federal Ministry of Research and Education, is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy – CECAD, EXC 2030 – 390661388 and has received research grants from Actelion, Amplyx, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, Janssen, Medicines Company, Melinta, Merck/MSD, Octapharma, Pfizer, and Scynexis; is a consultant to Actelion, Allecra, Amplyx, Astellas, Basilea, Biosys, Cidara, Da Volterra, Entasis, F2G, Gilead, Matinas, MedPace, Menarini, Merck/MSD, Mylan, Nabriva, Noxxon, Octapharma, Paratek, Pfizer, PSI, Roche Diagnostics, Scynexis, and Shionogi; and received lecture honoraria from Al-Jazeera Pharmaceuticals, Astellas, Basilea, Gilead, Grupo Biotoscana, Merck/MSD, and Pfizer.

Janne Vehreschild has received personal fees from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), University Hospital Freiburg/Congress and Communication, Academy for Infectious Medicine, University Manchester, German Society for Infectious Diseases (DGI), Ärztekammer Nordrhein, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine (DGIM) and grants from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), German Federal Ministry of Education and Research (BMBF), (PJ-T: DLR), University of Bristol, and Rigshospitalet Copenhagen.

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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)

Affiliations

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)

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials