Gram-positive infections in granulocytopenic patients: An important issue?

C. Viscoli, P. Van der Auwera, F. Meunier

Research output: Contribution to journalArticle

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Abstract

Gram-positive pathogens have become a common cause of bacteraemia in granulocytopenic cancer patients. This has been partially attributed to the use of central intravenous devices such as Hickman catheters; mucositis secondary to intensive antineoplastic chemotherapy or herpes infections may also be the source, especially for streptococci, whereas the skin is most probably the source for Staphylococcus epidermidis. Antimicrobial prophylaxis recommended mainly with the aim of reducing the incidence of Gram-negative bacillary infections may also play a significant role. The rate of response of documented infections caused by Gram-positive cocci to 'standard' empirical therapy (which has been mainly directed against Gram-negative bacilli) has been unsatisfactory although the lethality reported has been low. These results raise an important question, whether or not a specific anti-Gram-positive antibiotic such as vancomycin, should be added to the empirical regimen. A recent study suggested that empirical vancomycin provided no benefit since the mortality due to Gram-positive infections was low and a favourable outcome was obtained by adding a specific antibiotic after bacteriological documentation. However, others have shown that empirical use of vancomycin was associated with a more rapid resolution of fever. Vancomycin has been associated with an excess rate of side-effects and is difficult to administer. Another important question is whether or not antimicrobial prophylaxis for gut decontamination should include anti-Gram-positive cover. Recent studies have confirmed that Gram-negative bacillary bacteraemia may be prevented by oral gut decontamination but not bacteraemia due to Gram-positive bacteria. Whether more adequate prophylaxis could be obtained by the use of a specific anti-Gram-positive antibiotic with good salivary excretion in order to control oral streptococci is currently under investigation.

Original languageEnglish
Pages (from-to)149-156
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume21
Issue numberSUPPL. C
Publication statusPublished - 1988

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Vancomycin
Bacteremia
Decontamination
Anti-Bacterial Agents
Infection
Streptococcus
Gram-Positive Cocci
Mucositis
Staphylococcus epidermidis
Gram-Positive Bacteria
Documentation
Antineoplastic Agents
Bacillus
Fever
Catheters
Drug Therapy
Equipment and Supplies
Skin
Mortality
Incidence

ASJC Scopus subject areas

  • Microbiology
  • Pharmacology

Cite this

Gram-positive infections in granulocytopenic patients : An important issue? / Viscoli, C.; Van der Auwera, P.; Meunier, F.

In: Journal of Antimicrobial Chemotherapy, Vol. 21, No. SUPPL. C, 1988, p. 149-156.

Research output: Contribution to journalArticle

Viscoli, C. ; Van der Auwera, P. ; Meunier, F. / Gram-positive infections in granulocytopenic patients : An important issue?. In: Journal of Antimicrobial Chemotherapy. 1988 ; Vol. 21, No. SUPPL. C. pp. 149-156.
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