title: Bloodstream infections in neutropenic cancer patients: A practical update.
abstract: Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel de-escalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.
authors.affiliation: a Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST , Genova , Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gustinetti
authors.affiliation: a Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST , Genova , Italy.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Mikulska
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D019468:Disease Management; D024881:Drug Resistance, Bacterial; D064147:Febrile Neutropenia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D024841:Fluoroquinolones / Q000008:administration & dosage; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006801:Humans; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D065129:Pre-Exposure Prophylaxis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D000077725:Piperacillin, Tazobactam Drug Combination; D000077723:Cefepime; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: MDR bacteria; bloodstream infections; de-escalation; empirical treatment; febrile neutropenia; outpatient management