Management of bacterial infections in haematological patients

Abstract

The outlook of patients with serious haematological disease has been improved by increased understanding of the disease process and by the introduction of better therapy. However, the major benefit of the therapy is seldom achieved without toxicity. Myelosuppression and immunosuppression are frequent side effects with resultant increasing susceptibility to infection. Bacterial infections are often severe and frequently responsible for the death of these patients. Hence early recognition and treatment of bacterial infections is of primary importance. In the preantibiotic era, most fatal infections were caused by Streptococcus pneumoniae and Strep. pyogenes. The introduction of penicillin G caused an abrupt reduction in these infections. However, resistant strains of Staphylcoccus aureus soon emerged as the most important cause of infections (Hersh et al, 1965). The introduction of methicillin resulted in a dramatic fall in staphylcoccal infections and reduced the rate of fatal infections to less than 5 per cent (Bodey, 1971). A consequence of this observation has been the emergence of Gram-negative bacilli as the most common cause of serious infections in haematological patients (Norden, 1980).