THE CHANGING PATTERN OF INFECTION IN NEUTROPENIC PATIENTS

Over the past 20 years there has been a dramatic shift in the pattern of infection in neutropenic patients. During the 1970s Gram-negative o rganisms caused approximately 70% of all bacteraemias, but by the late 1980s the situation had reversed and approximately 70% of bacteraemia s were due to Gram-positive organisms. The main contributors to this i ncrease in Gram-positive infections have been the coagulase-negative s taphylococci and the viridans streptococci. More recently, enterococci have emerged as significant pathogens in this patient group, and the development of glycopeptide resistance in the enterococci is of partic ular concern since this class of antibiotics is widely used in neutrop enic patients. Among Gram-negative organisms, the emergence of resista nce to fluoroquinolones, particularly in Escherichia coli, is a worryi ng feature which may lead to a reassessment of the use of quinolone pr ophylaxis in this setting.