Journal Article

Changes in the Etiology of Bacteremia in Febrile Neutropenic Patients and the Susceptibilities of the Currently Isolated Pathogens

Reuben Ramphal

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue Supplement_1, pages S25-S31
Published in print July 2004 | ISSN: 1058-4838
Published online July 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/383048
Changes in the Etiology of Bacteremia in Febrile Neutropenic Patients and the Susceptibilities of the Currently Isolated Pathogens

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The etiology of bacteremia in febrile neutropenic patients in the past few decades has shifted from gram-negative to gram-positive organisms. Potential reasons include the use of indwelling catheters, local environmental conditions, and the administration of specific antibiotic agents, especially as prophylaxis. Other factors may emerge from new studies, such as the categorization of febrile neutropenic patients into groups at low risk and at high risk of developing serious complications, continuing changes in resistance in the community, the use of antibiotic-coated catheters, and future changes in cytotoxic chemotherapy or antineoplastic therapy. In addition, there has been a drift in susceptibility patterns, with resistance issues seen in the general population of hospitalized patients now emerging in febrile neutropenic patients, as well as some issues specific to these patients. These changes affect empirical therapy as it was practiced a decade ago. Among the most commonly used agents, cefepime and carbapenems continue to show the highest rates of in vitro susceptibility, providing coverage against most gram-positive and gram-negative organisms and reducing the need for glycopeptides. Older agents continue to show degradation of their effectiveness. Among Pseudomonas aeruginosa strains, susceptibility to all agents continues to decline.

Journal Article.  4148 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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