Antineoplastic Chemotherapy in Cancer Patients with Methicillin-Resistant Staphylococcus aureus (MRSA)

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen causing serious morbidity and mortality in immunosuppressed patients. Antineoplastic chemotherapy causes immunosuppression, and thus there is concern whether such patients should proceed to therapy without delay or dose reduction. There are presently no guidelines with appropriate provisions for antineoplastic chemotherapy in cancer patients with MRSA colonization or infection. Patients and Methods: We retrospectively analyzed the clinical outcome of all 27 patients with known MRSA infection or colonization undergoing antineoplastic chemotherapy for solid or hematological malignancies in our institution. Results: In our patients, MRSA was detected at multiple sites. 11 patients were found to be colonized with MRSA, whereas 16 patients had colonization and/or infection. MRSA sepsis occurred in 12 cases. Interestingly, at the time of MRSA sepsis, neutrophil counts were less than 500/mu l in 42% of our patients. However, fatal complications due to MRSA occurred in only 2 patients. Among patients with MRSA sepsis, the mortality rate was 14%. Conclusions: Our results with a limited number of patients support the contention that antineoplastic chemotherapy may well be administered to patients with MRSA and should not necessarily lead to dose reduction or treatment delay, especially in cases with curative intent.