Management of gram-positive bacterial infections in patients with cancer

Leuk Lymphoma. 2012 Jan;53(1):8-18. doi: 10.3109/10428194.2011.602770. Epub 2011 Aug 24.

Abstract

Bacterial infections, particularly those due to gram-positive bacteria, continue to predominate in patients with cancer. Coagulase-negative and coagulase-positive staphylococci and enterococci remain as common pathogenic microorganisms. Clostridium difficile has emerged as a significant pathogen. Major clinical syndromes include vascular catheter-related infection, febrile neutropenia, diarrhea and colitis. Rising antimicrobial resistance among gram-positive bacteria is of serious concern. The clinical utility of penicillin against streptococci and vancomycin against coagulase-negative and coagulase-positive staphylococci and enterococci may be rapidly diminishing. Liberal empiric use of vancomycin during neutropenic fever needs careful reconsideration. Newer promising anti-gram-positive bacterial drugs with activity against methicillin-resistant staphylococci include daptomycin, linezolid, tigecycline and telavancin. However, toxicity concerns, limited data in immunocompromised populations and high cost prevent the widespread use of these drugs among patients with cancer.

Publication types

  • Review

MeSH terms

  • Acetamides / adverse effects
  • Acetamides / therapeutic use
  • Aminoglycosides / adverse effects
  • Aminoglycosides / therapeutic use
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Daptomycin / adverse effects
  • Daptomycin / therapeutic use
  • Drug Resistance, Bacterial / drug effects
  • Gram-Positive Bacteria / drug effects*
  • Gram-Positive Bacterial Infections / complications
  • Gram-Positive Bacterial Infections / drug therapy*
  • Humans
  • Linezolid
  • Lipoglycopeptides
  • Minocycline / adverse effects
  • Minocycline / analogs & derivatives
  • Minocycline / therapeutic use
  • Neoplasms / complications*
  • Oxazolidinones / adverse effects
  • Oxazolidinones / therapeutic use
  • Tigecycline

Substances

  • Acetamides
  • Aminoglycosides
  • Anti-Bacterial Agents
  • Lipoglycopeptides
  • Oxazolidinones
  • Tigecycline
  • Minocycline
  • Linezolid
  • Daptomycin
  • telavancin