Lactobacillus species are part of normal gastrointestinal flora and are an uncommon cause of bacteremia. Lactobacillus casei subsp. rhamnosus was repeatedly isolated in the blood cultures of a 43-year-old woman with ulcerative colitis. Lactobacillus spp. could be considered a potential opportunistic pathogen whenever there is disruption of the physiologic architecture of the intestinal mucosa, such as in abdominal surgery, endoscopic procedures, or enteric pathologies. Clinicians and clinical microbiologists need to be aware of this infective complication in patients with ulcerative colitis.

Our model was thus able to identify patients at higher risk of death. These results confirm the importance of cancer geriatric assessment also for the clinical evaluation of oncological patients. Additional randomized studies with a larger number of patients, also in an adjuvant setting, should be performed to confirm the effectiveness of this approach.

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As regards the observations about our case report (Tumori, 93, 2007) made by Crivellari et al., we think that their comments are widely agreeable, particularly as regards the invitation to keep a careful eye on every chemotherapy, especially in the elderly. The provoking title of our work had the purpose to underline the need for particular attention in the care of elderly cancer patients. It is known that the side effects of a certain drug are not always predictable, since every patient has a peculiar genetic background, which can interfere with the susceptibility to treatments. In this case, the low dosage of the prescribed drug (if we assume that is was correctly ingested) cannot explain the severe toxicity observed. Even if oral administration is considered the simplest and safest way to deliver oncological treatments, our experience suggests that it may not always be true and sometimes there is no certainty about the dosage actually administered at home despite a clear medical prescription.