And Infection

Most infections in patients with severe neutropenia are caused by either aerobic Gram-negative bacilli, particularly Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, or Gram-positive cocci, particularly Staphylococcus aureus and a-hemolytic streptococci (2). In recent years, infections by S. aureus, including methicillin-resistant and vancomycin-resistant species, have been increasing (13). Infections by anaerobic organisms are relatively uncommon, although the microaerophilic organisms of the mouth contribute to gingivitis and mucositis in patients with neutropenia. For unclear reasons, clostridial infections, including bac-teremias, occur in patients with various forms of chronic neutropenia; however, clostridial blood stream infections occur infrequently in patients with chemotherapy-induced neutropenia. Clostridia difficile, however, is an important cause of diarrhea, abdominal pain, and fever in all patients with neutropenia, particularly after exposure to broad-spectrum antibiotics. Infections by mycobacteria including Mycobacterium tuberculosis are generally not a problem with conventional chemotherapy. Tunnel infections of indwelling venous catheters by atypical mycobacteria, as well as by Gram-positive cocci, are always a concern.

Over the past two decades, mycotic infections in patients with severe neutropenia have steadily increased (14). Fungal infections are a greater problem with prolonged neutropenia and antibiotic administration in the setting of hematopoietic stem cell transplantation and high-dose chemotherapy than with conventional chemotherapy for solid tumors (15). Predisposing factors for fungal infections include diabetes mellitus and corticosteroid treatment. Most infections are caused by Candida species, and an increased proportion is caused by resistant organisms (16). Major morbidity and mortality continue to be associated with infections by invasive molds, especially Aspergillus and Fusarium species. By the time these invasive molds are clinically recognized with current techniques, the chance of survival is generally <50%, even with optimal therapy (17).

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