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

Abstract

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.

Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Bloodstream Infections in Children with Febrile Neutropenia: Experience of Single Center in Southeast of Turkey

“…The main change reported has been the reduction in the occurrence of bacteremia due to gram-negative organisms, with a shift to gram-positive organisms [4,5]. The causes of this change in the epidemiology of the infection have not been clearly identified, but they may include more aggressive radiotherapy and chemotherapy, more profound and prolonged neutropenia, increased use of intravenous catheters, and selective pressure of antibiotics [4,5].…”

“…The causes of this change in the epidemiology of the infection have not been clearly identified, but they may include more aggressive radiotherapy and chemotherapy, more profound and prolonged neutropenia, increased use of intravenous catheters, and selective pressure of antibiotics [4,5]. It was previously reported that identification of the causative microorganisms of infection is possible in only 22-39% of cases [6][7][8].…”

Risk of Infections in Adult Patients with Haematological Malignancies

“…Some of the factors implicated in the increasing number of Gram-positive bacteraemias were the administration of aggressive chemotherapy and radiotherapy regimens that induced severe mucositis, increased use of indwelling catheters, the widespread use of fluoroquinolones as prophylactic agents, and empirical antibiotic treatment with high activity against Gram-negative infections [25][26][27]. Yet, this shift towards Gram-positive bacteraemias has not been global.…”

Infecciones en pacientes oncohematológicos no trasplantados

“…Se considera que un paciente tiene neutropenia cuando la cifra absoluta de neutrófilos es menor de 1.000/mm 3 . El riesgo de infección aumenta con la severidad de la neutropenia, duración de ésta, control de la neoplasia, intensidad del tratamiento quimioterápico, daño en las barreras naturales (piel, mucosas), empleo de catéteres tunelizados, realización de procedimientos invasivos, enfermedad dental, empleo de profilaxis antifúngica y alteraciones coexistentes de la inmunidad celular o humoral.…”