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Patients with cancer are subject to infections as a result of several factors, notably
obstruction or constriction of airways or ducts, erosion of tumour involving the protective
integument or mucosa, alteration of host defenses secondary to infiltration of bone
marrow, reduced or altered immunoglobulin or cytokine production, or as a result of
chemotherapy. Specific infecting organisms may be predicted based on the specific
defect in host defenses. For example, patients with myeloma or lymphocytic leukaemia
may develop infections with encapsulated bacteria as a result of decreased B-lymphocyte
numbers or function, and those with lymphomas may incur a variety of intracellular
bacterial, fungal, and viral infections as a result of decreased T-lymphocyte function.
Neutropenia is the most frequently encountered host cell defect in patients with cancer
and predicts the development of bacteraemia caused by Gram-positive and Gram-negative
bacteria. Recent changes in microbial ecology and antimicrobial resistance profiles
have highlighted the need for continued reevaluation of antimicrobial therapy in these
patients. Several new antibiotics with enhanced activity against organisms frequently
isolated from patients with cancer have been introduced and studied recently. The
International Antimicrobial Therapy Cooperative Group of the EORTC has studied meropenem
alone, piperacillin/tazobactam, and ceftriaxone, each with single daily dose amikacin;
these regimens compare favourably with ceftazidime plus amikacin for empirical treatment
of fever in neutropenic patients. Preventive measures are important, if understudied,
and the optimal antibiotic approach to prophylaxis remains unclear. Adjunctive measures
including prophylactic and therapeutic colony-stimulating factors play an important
role.
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© 1997 Published by Elsevier Inc.
