Empiric Therapy of Bacterial Infections in Patients with Severe Neutropenia

Abstract

The urgent need to treat presumptive infections in neutropenic patients has meant that initial therapy is empiric based on the pathogens most likely to be responsible for the patient’s rise in temperature or other symptoms of infection. The spectrum of causative pathogens has changed over time and reflects the availability and use of antimicrobial agents. Gram-positive organisms predominated in the 1940s and onward until the widespread use of early penicillins and cephalosporins effectively addressed this problem. The upsurge in infections in the 1970s and 1980s caused by Gram-negative organisms, particularly Pseudomonas aeruginosa, Escherichia coli and Klebsiella spp., has been supplanted by a new wave of infections caused by Gram-positive organisms, this time predominantly Staphylococcus aureus, Staphylococcus epidermidis, and the viridans streptococci. The fourth-generation cephalosporins (cefpirome) among other broad-spectrum β-lactams, by virtue of their enhanced antimicrobial activity against Gram-positive pathogens and greater β-lactamase stability, are promising candidates for use in the empiric management of febrile episodes in neutropenic patients. Early clinical trial results are promising and should lead the way for further use of these compounds in this indication.