Infections in neutropenic cancer patients

Abstract

Severe infections duue to gram negative bacilli, staphylococci, enterococci and candida species are common in cancer patients due to profound neutropenia during aggressive therapy. Altered gut flora because of frequent antibiotics administration, disruption of skin and mucous membranes by invasive devices and damage of epithelial surfaces by cytotoxic agents also contribute for the development of infections. Frequent hand washing or the use of gloves which must be changed after each examination as well as barrier techniques reduce hospital bsed infections. Flouroquinolones are required to prevent infections from patient's own endogenous microbial flora. Frequency and severity of bacterial and fungal infections despite preventive measures, however, necessitates empiric antibiotic combination therapy. Third generation cephalosporins in combination withh ureidopenicillin or aminoglycosides are recommended to combat gram negative bacterial infections. Vancomycin may be required to treat gram positive infections. Antifungals are added at 72 hours or subsequently if fever and/or general condition of patient deteriorates. For severe neutropenia of longer duration, such as that seen among bone marrow transplant recipients and among those undergoing aggressive chemotherapy for acute leukemia, prophylactic antifungal therapy in addition to antibacterial gut prophylaxis appears justified.