GRAM-POSITIVE COCCI INFECTIONS IN CANCER-PATIENTS

Gram-positive cocci are more and more involved in infections in neutropenic and cancer patients. Coagulase negative staphylococci are the most frequent bacteria isolated in these patients. The risk factors for coagulase negative staphylococcus infection are the presence of a central venous line, of a severe and prolonged neutropenia and of an oropharyngeal mucositis which is a common complication of intensive chemotherapy. Coagulase negative staphylococci are very often methicillin-resistant and the use of a glycopeptide is required in large number of cases. Staphylococcus aureus infections are less frequent but often severe. The mortality rate is especially high in case of septic pulmonary localizations. Streptococcal infections, and especially when due to Streptococcus pneumoniae, may have an hyperacute presentation. Viridans streptococcal infections occur mainly in leukemic patients treated with high dose cytarabine. In these patients the portal of entry is the buccal mucosa damaged by the chemotherapy. Splenectomy and hypogammaglobulinemia contribute to disseminated pneumococcal infections. The most frequent underlying diseases in pneumococcal infections are Hodgkin's disease, multiple myeloma and lung cancer. Enterococcal bacteremia represent usually less than 3% of all bacteremia in cancer patient. Nevertheless their prognosis is severe and the mortality rate may be high.