[Changes in the epidemiology of infections in patients with febrile neutropenia]

Over the last years, advances in the treatment and supportive care of patients with cancer have led to substantial improvement in long-term survival. Nevertheless, bacterial infection continues to contribute significantly to illness and death in patients developing chemotherapy-induced neutropenia. In this severely ill population, the early administration of appropriate empirical antibiotic therapy for febrile episodes is crucial. This therapeutic approach has been shown to decrease morbidity and mortality due to infections caused by gram negative bacilli. However, in recent years, gram positive pathogens have been recovered at a notably increased rate from neutropenic patients with cancer. Although mortality associated to gram positive bacteremia is commonly lower than that caused by gram negative bacilli, an increasing frequency of serious complications of bacteremia due to viridans group streptococci has been observed in some institutions. Moreover, the emerging problems of bacterial resistance to various antimicrobial agents is of great concern. Herein, we examine major changes in the epidemiology of bacterial infections in neutropenic patients with cancer and some clinical aspects of infections caused by most frequent pathogens.