Update on bacterial infections in immunosuppressed patients

Abstract

A multidisciplinary group of physicians with expertise in infections in neutropenic and hemato-oncology patients met to discuss the state of the art and the most relevant publications in the field of bacterial infection in neutropenic patients during the last two years. The group agreed that most studies are favorably inclined toward the use of prophylaxis in this setting, although several areas have yet to be clarified, such as identification of the patients at greatest risk and the period of increased risk, and the emergence of resistant organisms. Several papers on vancomycin as empirical therapy in febrile patients with neutropenia were discussed. Currently available evidence does not support the need for empirical glycopeptides initially, nor for persistent fever. Withholding specific treatment against Gram-positive infections pending growth of a resistant Gram-positive organism was considered as safe. As for the management of bacterial infection in low-risk patients with neutropenia, current data indicate that, even in this group, empiric coverage with broad-spectrum antibiotics is necessary, at least until culture results become available. Finally, the role of Streptococcus pneumoniae as a bacterial agent of infection in hematology-oncology patients revealed the low incidence of the problem, the community origin of most episodes, the frequent association with pneumonia, and related mortality not superior to that of the non-neutropenic population.