PREVENTION OF GRAM-NEGATIVE INFECTIONS IN NEUTROPENIC CANCER-PATIENTS

Despite the modern advances in the clinical management of neutropenic cancer patients, infection remains the major cause of morbidity and mo rtality associated with neutropenia. Gram-negative bacilli are an impo rtant cause of death associated with infection in these patients. Gram -negative bacilli generally arise from the patient's own endogenous fl ora or are acquired during hospitalization. Recognition of the damaged host defence mechanisms, the routes of acquisition, and the sites of potential pathogen colonization suggest a variety of preventive measur es. These include reducing the traumatic procedures, surveillance for the infecting pathogens, environmental control, suppressing the coloni zing pathogens and the use of antimicrobial prophylaxis. Indeed, Gram- negative bacilli infection has been greatly reduced when different tec hniques, such as the use of laminar air-flow room reverse isolation wi th filtered air, diets low in microbial contents and suppression of mi crobial flora with antimicrobials. This, however, should be monitored by the use of surveillance cultures and hospital infection control pro grammes. Recently, use of quinolones as a prophylaxis has been very ef fective and this has a potential advantage against Gram-negative bacil li due to their good therapeutic levels when administered orally.