Bloodstream infections in neutropenic cancer patients: A practical update

Abstract

Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

An overview of infectious complications after allogeneic hematopoietic stem cell transplantation

“…Historically, gram-negative bacilli, especially Pseudomonas aeruginosa were the most commonly seen pathogens [15]. However, gram-negative bacterial infections are still associated with a high mortality rate and the frequency of infections with multi-drug resistant strains has been increasing within the last decade [16]. In the early phases, antibacterial prophylaxis plays a quite important role.…”

Gut microbiota‐immune‐brain interactions in chemotherapy‐associated behavioral comorbidities

“…34 Chemotherapy also profoundly affects the intestinal barrier, which functions to keep resident bacteria from triggering an innate immune response. [35][36][37] Disturbances in the mucus layer, tight junctions, and overall tissue integrity result in the translocation of bacterial products (eg, lipopolysaccharide) leading to endotoxemia 35 or of whole bacteria (leading to bacteremia) 37 and general inflammatory responses. Although alterations in fecal microbiota after chemotherapy have been linked to the development of mucositis as well as cancer-related cachexia, 28,35 the extent to which these alterations are associated with behavioral outcomes has yet to be reported.…”

Diagnostic performance of procalcitonin, presepsin, and C‐reactive protein in patients with hematological malignancies

“…Fever is frequently encountered as a complication in patients with hematological malignancies who undergo intensive chemotherapy or hematopoietic stem cell transplantation (HSCT) . The most common cause of fever is infection.…”