Gram-Negative Infections

During the last 50 years, two major shifts could be noticed in the epidemiology of bacteria causative for infections and particularly bloodstream infections in febrile neutropenic cancer patients. Until the mid-1980s, gram-negative bacteria, particularly Escherichia coli and Pseudomonas aeruginosa, were the main infectious agents in these patients. Then, presumably due to the increased use of high-intensity chemotherapeutic regimens leading to a higher incidence of severe mucositis, the frequent use of fluoroquinolone (FQ) prophylaxis and indwelling long-term vascular catheters, gram positives, particularly coagulase-negative staphylococci and viridans streptococci, became the dominant infecting agents.