Figure 1. The “Catch 22” relationship between antimicrobial therapy and cancer treatment in the oncology patient.

This figure depicts how depletion of native commensals by antibacterial prophylaxis and empirical treatment of neutropenic fevers or suspected infections is compounded by mucosal barrier injury from cytotoxic chemotherapy, leading to proliferation of pathogenic bacteria, translocation across disrupted intestinal epithelium, and subsequent resistant infections. This leads to a vicious cycle of re-current infectious issues and other cancer treatment related toxicities as a result of antibiotic induced microbial dysbiosis.