Epidemiology and etiology

The microorganisms responsible for infections in neutropenic patients have changed significantly in the last 50 years. From the 1960s through the mid-1980s, gram-negative organisms were the most common bacteria isolated. This pattern shifted to the gram-positive organisms in the late 1980s, which remain the most common isolates. Recent data indicate that gram-positive organisms account for 62% to 76% of all bloodstream infections.15 The causes of this change are attributed to the widespread use of central venous catheters and more aggressive chemotherapy regimens as well as the use of prophylactic antibiotics with relatively poor gram-positive coverage (quino-lones). Commonly isolated pathogens are shown in Table 99-4. Although gram-negative infections are less common, they cause the majority of infections in sites other than the blood and are particularly virulent. It should be noted that isolates vary considerably among institutions thus attention to institutional isolation patterns is prudent.

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