THE CHANGING EPIDEMIOLOGY OF INFECTIONS AT CANCER HOSPITALS

Intensive chemotherapy regimens, widespread prophylactic and therapeut ic administration of antibiotics, reliance on intravascular catheters, increased use of immunomodulators, and increased outpatient managemen t have altered the epidemiology of infections in patients with neoplas tic disease. At many centers, bacteremias due to gram-positive organis ms have replaced bacteremias due to gram-negative organisms as the mos t frequent infections in patients with cancer. Isolation of gram-negat ive bacilli other than Enterobacteriaceae and Pseudomonas aeruginosa h as increased in frequency, and these organisms have become important p athogens. Fungal infections have become a leading cause of morbidity a nd mortality, and nosocomial fungemias have become more common than no socomial bacteremias due to gram-negative bacilli in some centers. Myc obacterium tuberculosis, Pneumocystis carinii, and rubeola virus have re-emerged as disease-causing entities in patients with cancer. Multir esistant organisms have developed over the past decade. Anticipated tr ends in infections in patients with cancer also are discussed.