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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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