Infections in Patients with Hematological Malignancies

Infectious complications are an important cause of morbidity and mortality in patients with hematological diseases, especially during chemotherapy induced neutropenia. This study was undertaken with the ultimate goal to improve the clinical management of infections in patients with hematological diseases. In a relatively large hematology centre where antibiotic prophylaxis was generally not used, the incidence of bacteremia and the spectrum of causative pathogens during the period 19882001, were determined. No tendency to a shift from gram-negative to gram-positive etiology was noted. Except for a significant increase in Enterococcus faecium bacteremia, the species distribution was essentially stable. The rates of antimicrobial resistance were low. The 7and 30day mortality rates were 6.3 and 15.6%, respectively. Species distribution and triazole susceptibility of colonising yeasts in neutropenic patients treated for hematological malignancies were prospectively analysed. Previous exposure to fluconazole prophylaxis was not associated with a shift from Candida albicans to non-albicans Candida species. However, fluconazole MICs were significantly higher in yeast isolates from patients who had received prophylaxis, indicating that azole prophylaxis may contribute to the emergence of less susceptible yeast strains. Cefepime monotherapy was, in a prospective randomised study, found to be as safe and as effective as imipenem-cilastatin in the management of febrile neutropenia in patients treated for hematological malignancies. In patients with neutropenia and fever of unknown origin (FUO), the early discontinuation of all antibiotic therapy 48 hours after fever defervescence was not associated with an increased rate of fever relapse or mortality. This therapeutic approach seems promising in patients with FUO. Prospective large randomised trials are warranted. The Multinational Association of Supportive Care in Cancer (MASCC) risk-index score was validated in patients with hematological malignancies. The risk-index identified patients with febrile neutropenia who were at low risk for the development of serious medical complication with a specificity, sensitivity and positive predictive value of 87%, 58% and 84%, respectively. Accordingly, this risk-index was found to be a valuable tool for the identification of low-risk