Table 1. Common Infections in Cancer Patients, Frequency and Treatment.
| Organism | Frequency | Treatment |
|---|---|---|
| S. aureus | Between 1.3% and 12% of bacteremia cases [15] | Methicillin-susceptible S. aureus should be treated with an anti-staphylococcal beta-lactam (i.e., cefazolin or nafcillin). |
| Nearly 27% of skin and soft tissue infections [14] | Methicillin-resistant S. aureus should be treated with vancomycin. | |
| About 26% of pneumonia cases [14] | Venous catheter removal recommended | |
| Viridans group streptococci | Occurred in about 23% of children with AML being treated with chemotherapy [17] | No well-defined, optimal therapy |
| S. agalactiae | Accounts for > 80% of recurrent infections following streptococcal bloodstream infections [16] | Treat with penicillins or cephalosporins |
| S. pneumoniae | Accounts for about 6.5% of episodes of bacteremia [18] | Treat with levofloxacin or vancomycin |
| Enterococcus species | Disproportionately found in cancer patients; 15-20% are vancomycin resistant. | Vancomycin resistant Enterococcus should be treated with daptomycin or linezolid |
| E. faecalis should be treated with one of the penicillins | ||
| E. coli | Over 20% of gram-negative bacteremia cases are attributed to E. coli infection. | Treat with carbapenems |
| Associated mortality is over 15% | ||
| Klebsiella species | Klebsiella pneumoniae carbapenemase-producing K. pneumonia, greater than 70% mortality for bacteremic infections | Treat with tigecycline and piperacillin/tazobactam |
| P. aeruginosa | Declining prevalence secondary to antibiotic coverage | Treat with piperacillin/tazobactam and venous catheter removal recommended |
| Candida species | Incidence varies widely across studies | Treat with fluconazole. May also offer fluconazole prophylaxis for highest risk patients. |
| Patients with acute leukemia are at the highest risk for developing invasive candidiasis during episodes of post-chemotherapy neutropenia | ||
| Aspergillus species | Incidence of 4-15% and a mortality of 60-85% | Treat with azoles or caspofungin |
| HSV-1 and 2 | Reactivation present in two-thirds of seropositive patients who undergo induction chemotherapy for acute myeloid leukemia | Treat aggressively with acyclovir |
| Varicella zoster virus (VZV) | Reactivation of VZV causes herpes zoster in an average of 5 months following the initiation of chemotherapy in lymphoma patients | Prophylactic acyclovir should be considered in patients with an extended duration of low lymphocyte count or long-term steroid use to prevent the poor clinical course associated with visceral disseminated VZV infection. |
| Community-acquired respiratory viruses | The risk for infection via CARVs mirrors respiratory virus outbreaks in the general population [19]. The degree, duration, and type of immunosuppression at patient are receiving directly correlates to the severity of CARV infections [20]. | Supportive care |
S. aureus: Staphylococcus aureus; AML: acute myeloid leukemia; S. agalactiae: Streptococcus agalactiae; S. pneumoniae: Streptococcus pneumoniae; E. faecalis: Enterococcus faecalis; E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; HSV: herpes simplex virus; CARVs: community-acquired respiratory viruses.