Healthcare-associated infections in patients who are immunosuppressed due to chemotherapy treatment: a narrative review

Abstract

Introduction: Chemotherapy is one of the best methods to cure oncologic patients. However, it leads to adverse effects that contribute to the establishment of infections. Up-to-date knowledge is needed to offer the best care to patients.

Methodology: This is a narrative review based on searching articles in five databases (PubMed, LILACS, Research Gate, Google Scholar, and SciELO) using “cancer treatments”, “chemotherapy”, “febrile neutropenia”, “cancer opportunistic infections”, “chemotherapy AND febrile neutropenia”, “cancer AND hospital infections”, and “immunosuppression AND cancer patients” as keywords. No filter was applied, however, articles published in the last five years were preferentially selected to compose this article.

Results: Almost all microorganisms can cause infection in cancer patients, including colonizing and normal microbiota. However, Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp., Staphylococcus spp., and Streptococcus spp. are the most reported agents. Viruses may be underrepresented because molecular techniques are needed to identify them. Bloodstream and associated infections are among the highest occurrences because of the devices that are constantly introduced. Antibiotic administration selects for resistant microorganisms, which leads to delay or even failure in the treatment. Protocols for efficient infection prevention and control measures must involve staff from the kitchen, janitors, nurses, and physicians, in addition to patients and relatives.

Conclusions: Bloodstream infections caused by the bacteria and which have the most resistance to several antimicrobials are the main concern for oncologic patients. Preventive and educative actions must be taken by a multidisciplinary team in order to achieve the best care for the vulnerable patients.