title: Changing patterns of infections and antimicrobial susceptibilities.
abstract: Nosocomial bloodstream infections across the United States and in Europe are increasingly attributable to gram-positive species--a trend that represents a reversal of the gram-negative predominance of the previous decades. Data from Memorial Sloan-Kettering Cancer Center and elsewhere show that patients with hematologic malignancies or patients who are immunocompromised because of anticancer treatments are experiencing this shift in microbial spectrum. Most common among gram-positive species are coagulase-negative Staphylococci. Antimicrobial resistance continues to increase, which makes treatment more difficult for infections caused by some species, especially vancomycin-resistant enterococcal species. The underlying causes of changes in microbial spectrum and drug-resistance patterns are incompletely understood, but it is clear that antibiotic exposure exerts a significant selective pressure on pathogens, resulting in partial or complete resistance. New drugs or drug combinations will be necessary to treat drug-resistant infections in cancer patients.
authors.affiliation: Charité University Hospital, Robert Roessle Cancer Center Hematology, Oncology and Tumor Immunology, Berlin, Germany. maschmeyer@rrk-berlin.de
authors.forename: G
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: G A
authors.initials: GA
authors.lastname: Noskin
authors.forename: P
authors.initials: P
authors.lastname: Ribaud
authors.forename: K A
authors.initials: KA
authors.lastname: Sepkowitz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005544:Forecasting; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents