The current spectrum of infection in cancer patients with chemotherapy related neutropenia

Abstract

Despite advancements in the treatment and supportive care of patients with malignant disorders, neutropenia remains the major side effect of most antineoplastic regimens. Infections occur frequently in neutropenic patients and are associated with considerable morbidity and mortality. The spectrum of infection continues to change, and is influenced by various factors including local epidemiology, the use of chemoprophylaxis, and the use of central venous catheters and other medical devices. Bacterial infections are common in the early stages of neutropenia, with fungal infections emerging if neutropenia persists beyond 7-10 days. Gram-positive organisms cause most bacteremic infections (although this trend appears to be changing), whereas infections at other sites are often caused by Gram-negative bacilli or are polymicrobial, especially if deep tissue infection is present. Candida spp., and Aspergillus spp., remain the most common fungal pathogens, although several opportunistic fungi have emerged. Resistance to antimicrobial and antifungal agents commonly used for the prevention and treatment of infections in neutropenic patients has become a significant problem. The prompt administration of appropriate, empiric, antimicrobial therapy, prior to the availability of microbiological culture results, is the standard of care. Up to date knowledge of the spectrum of infection and local susceptibility/resistance patterns, is critical. In this report, we describe the current spectrum of infection in patients with malignancies and neutropenia, and emphasize the fact that local and geographic differences are not infrequent. We recommend that individual institutions conduct periodic epidemiological surveys in order to have the latest data available for the optimal management of their patients.

Bloodstream infections in neutropenic cancer patients: A practical update

“…55 Also non-fermenting GN rods harbor frequently this type of resistance. In fact, P. aeruginosa, which is responsible for 15-20% of GN infections, 56 might be frequently carbapenem-resistant in some regions, as demonstrated in an Italian multicenter cohort, where 71% of strains were MDR. 32 In other regions, as reported by studies from India or South Korea, A. baumannii has emerged as a common pathogen isolated in BSIs in neutropenic patients, and it is frequently resistant to cephalosporins or carbapenems.…”

A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy

“…Unfortunately, these treatment options are often associated with profound immunosuppression, mucosal damage and thus carry an increased risk of infection. Neutropaenia-not only quantitative but also qualitative-remains the most common adverse event of anti-neoplastic chemotherapy (Nesher and Rolston 2014). These defects include significant reduction in phagocytosis, decreased bactericidal and fungicidal activity, decreased production of superoxide anions, and defects in granulocyte locomotion.…”

“…Under strict hygiene measures, most microbiologically documented infections arise from the patient's endogenous micro-flora, with only a small proportion being acquired from exogenous sources or as a result of environmental exposure. Patients with severe oral mucositis are likely to have infections caused by viridans group Streptococci (VGS) and Stomatococcus mucilaginosus but coagulase-negative Staphylococci, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli are also often encountered beside microorganisms of the normal oral flora (Nesher and Rolston 2014). Several recent epidemiologic surveys in adult and paediatric patients from various parts of the globe have documented the predominance of Gram-positive organisms over Gram-negative bacilli as causes of microbiologically documented infections in neutropaenic patients (Nesher and Rolston 2014).…”

“…Patients with severe oral mucositis are likely to have infections caused by viridans group Streptococci (VGS) and Stomatococcus mucilaginosus but coagulase-negative Staphylococci, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli are also often encountered beside microorganisms of the normal oral flora (Nesher and Rolston 2014). Several recent epidemiologic surveys in adult and paediatric patients from various parts of the globe have documented the predominance of Gram-positive organisms over Gram-negative bacilli as causes of microbiologically documented infections in neutropaenic patients (Nesher and Rolston 2014). Some of the reasons for this predominance include the almost universal use of central venous catheters in such patients, the use of antimicrobial prophylaxis directed primarily against enteric Gram-negative bacilli, and last but not least the frequent use of chemotherapy that produces significant oral mucositis (Nesher and Rolston 2014).…”

“…Several recent epidemiologic surveys in adult and paediatric patients from various parts of the globe have documented the predominance of Gram-positive organisms over Gram-negative bacilli as causes of microbiologically documented infections in neutropaenic patients (Nesher and Rolston 2014). Some of the reasons for this predominance include the almost universal use of central venous catheters in such patients, the use of antimicrobial prophylaxis directed primarily against enteric Gram-negative bacilli, and last but not least the frequent use of chemotherapy that produces significant oral mucositis (Nesher and Rolston 2014).…”