Bacteremia in Neutropenic Patients

  • Sheila Hernandez
  • Ana Paula VelezEmail author
  • Jorge Lamarche
  • John N. Greene


Neutropenic patients are predisposed to polymicrobial infections that may cause substantial morbidity and mortality. Neutropenia is defined as a neutrophil count of <500 cells/mm3, or a count of <1000 cells/mm3 with a predicted decrease to <500 cells/mm3. Many factors play a role in the development of bacteremia such as the use of cytotoxic chemotherapy that leads to neutropenia, and also contributes to the disruption of skin and mucosal barriers. Moreover, exposure to pathogens is possible due to the frequent utilization of foley catheters and venous catheters in patients with cancer (Rolston et al., Clin Infect Dis 45(2):228–233, 2007). Lastly, the use of prophylactic antibiotics can lead to breakthrough MDR bacteria limiting antimicrobial options for therapy (Rolston et al., Clin Infect Dis 45(2):228–233, 2007; Perez et al., Clin Infect Dis 59(Suppl 5):S335–S339, 2014).

Both gram-negative and gram-positive organisms are culpable for infection in these immunocompromised patients. Although gram-negative bacteremia is still a leading cause in most recent years, infections by gram-positive bacteria have increased. This could be secondary to the wide use of long-term vascular catheters (Holland et al., Clin Infect Dis 59(Suppl 5):S331–S334, 2014; Baskaran et al., Int J Infect Dis: IJID: Off Publ Int Soc Infect Dis 11(6):513–517, 2007).

The most common microorganisms that cause bacteremia in neutropenic patients are the Enterobacteracie group, Pseudomonas aeruginosa , Staphylococcus aureus, Coagulase negative Staphylococci, and streptococcus species. In addition, other species will be discussed in this chapter (Rolston et al., Clin Infect Dis 45(2):228–233, 2007; Baskaran et al., Int J Infect Dis: IJID: Off Publ Int Soc Infect Dis 11(6):513–517, 2007; Yadegarynia et al., Caspian J Int Med 4(3):698–701, 2013).

Less common bacteria including nocardia and mycobacterium spp will not be discussed in this chapter.


Viridans Group Streptococci (VGS) Toxic shock-like syndrome Stenotrophomona Maltophilia VRE colonization C. jeikeium Rothia mucilaginosa Fusobacterium necrophorum F. nucleatum Carbapenemase-producing Klebsiella pneumoniae (KPC) Pseudomonas aeruginosa MRSA Multidrug resistant (MDR) 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sheila Hernandez
    • 1
  • Ana Paula Velez
    • 2
    Email author
  • Jorge Lamarche
    • 3
  • John N. Greene
    • 4
  1. 1.International Scholar at Moffitt Cancer CenterTampaUSA
  2. 2.University of South FloridaTampaUSA
  3. 3.USF Morsani College of Medicine James Haley VA HospitalJames Haley VA HospitalTampaUSA
  4. 4.USF Morsani College of MedicineMoffitt Cancer Center and Research InstituteTampaUSA

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