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The changing pattern of infection in neutropenic patients
1Public Health Laboratory, Withington Hospital, West Didsbury, Manchester, UK.
Abstract:
Over the past 20 years there has been a dramatic shift in the pattern of infection in neutropenic patients. During the 1970s Gram-negative organisms caused approximately 70% of all bacteraemias, but by the late 1980s the situation had reversed and approximately 70% of bacteraemias were due to Gram-positive organisms. The main contributors to this increase in Gram-positive infections have been the coagulase-negative staphylococci and the viridans streptococci. More recently, enterococci have emerged as significant pathogens in this patient group, and the development of glycopeptide resistance in the enterococci is of particular concern since this class of antibiotics is widely used in neutropenic patients. Among Gram-negative organisms, the emergence of resistance to fluoroquinolones, particularly in Escherichia coli, is a worrying feature which may lead to a reassessment of the use of quinolone prophylaxis in this setting.
Insights
Neutropenic patients now face more Gram-positive infections, a shift from previous decades. Antibiotic resistance in these pathogens, like enterococci, is a growing concern for treatment strategies.
Area of Science:
- Infectious Diseases
- Hematology
- Clinical Microbiology
Background:
- Historically, Gram-negative bacteria dominated bloodstream infections in neutropenic patients during the 1970s.
- A significant epidemiological shift occurred by the late 1980s, with Gram-positive organisms becoming the predominant cause of bacteraemia.
- Key Gram-positive pathogens include coagulase-negative staphylococci and viridans streptococci, with enterococci emerging as a significant threat.
Purpose of the Study:
- To analyze the changing patterns of bacterial infections in neutropenic patients over the past two decades.
- To highlight the increasing prevalence of Gram-positive infections and associated antimicrobial resistance.
- To discuss the implications of emerging resistance for treatment and prophylaxis strategies in neutropenic populations.
Main Methods:
- Retrospective analysis of infection patterns in neutropenic patients.
- Review of epidemiological data on bacteraemia causative agents.
- Assessment of antimicrobial resistance trends, particularly for Gram-positive and Gram-negative organisms.
Main Results:
- A reversal in the dominant bacterial cause of bacteraemia in neutropenic patients, from Gram-negative to Gram-positive organisms.
- Increased incidence of infections caused by coagulase-negative staphylococci, viridans streptococci, and enterococci.
- Emergence of glycopeptide resistance in enterococci and fluoroquinolone resistance in Gram-negative bacteria, notably Escherichia coli.
Conclusions:
- The changing microbial landscape necessitates a re-evaluation of empirical antibiotic therapy for neutropenic patients.
- Antimicrobial stewardship is crucial, especially concerning the rise of resistant Gram-positive pathogens and fluoroquinolone resistance in Gram-negative bacteria.
- Further research into novel therapeutic strategies and resistance surveillance is warranted to optimize patient outcomes.