Journal Article

Changing Epidemiology of Infections in Patients with Neutropenia and Cancer: Emphasis on Gram-Positive and Resistant Bacteria

Stephen H. Zinner

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 3, pages 490-494
Published in print September 1999 | ISSN: 1058-4838
Published online September 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/598620
Changing Epidemiology of Infections in Patients with Neutropenia and Cancer: Emphasis on Gram-Positive and Resistant Bacteria

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Over the past 3 decades, considerable changes have occurred in the types of bacteria causing infection in febrile patients with neutropenia and cancer. Twenty years ago, gram-negative bacteria caused ∼70% of bloodstream infections, As a probable consequence of long-dwelling intravascular devices, f1uoroquinolone prophylaxis, and high-dose chemotherapy-induced mucositis, there has been a shift toward gram-positive coccal bacteremia. In most centers today, ∼70% of bacteremic isolates are gram-positive cocci. Of potential concern is that antimicrobial-resistant gram-positive organisms are becoming increasingly frequent in patients with neutropenia. Fluoroquinoloneresistant Escherichia coli are being isolated from several cancer centers, Several “new” organisms, such as Stomatococcus mucilaginosus, Bacillus cereus, Leuconostoc species, Corynebacterium jeikeium, Rhodococcus species, Stenotrophomonas maltophilia, Moraxella catarrhalis, Burkholderia cepacia, and Bartonella species, now cause infections in these patients. Careful application of infection-control principles, judicious prophylaxis, appropriate evaluation of new antibiotics, and prompt effective therapy will maximize benefits for these patients.

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

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