World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Review

Volume 12, Number 6, December 2021, pages 195-205

Infections in Hospitalized Cancer Patients

**Table 1.** Common Infections in Cancer Patients, Frequency and Treatment
Organism	Frequency	Treatment
S. aureus: Staphylococcus aureus; AML: acute myeloid leukemia; S. agalactiae: Streptococcus agalactiae; S. pneumoniae: Streptococcus pneumoniae; E. faecalis: Enterococcus faecalis; E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; HSV: herpes simplex virus; CARVs: community-acquired respiratory viruses.
S. aureus	Between 1.3% and 12% of bacteremia cases [15]	Methicillin-susceptible S. aureus should be treated with an anti-staphylococcal beta-lactam (i.e., cefazolin or nafcillin).
	Nearly 27% of skin and soft tissue infections [14]	Methicillin-resistant S. aureus should be treated with vancomycin.
	About 26% of pneumonia cases [14]	Venous catheter removal recommended
Viridans group streptococci	Occurred in about 23% of children with AML being treated with chemotherapy [17]	No well-defined, optimal therapy
S. agalactiae	Accounts for > 80% of recurrent infections following streptococcal bloodstream infections [16]	Treat with penicillins or cephalosporins
S. pneumoniae	Accounts for about 6.5% of episodes of bacteremia [18]	Treat with levofloxacin or vancomycin
Enterococcus species	Disproportionately found in cancer patients; 15-20% are vancomycin resistant.	Vancomycin resistant Enterococcus should be treated with daptomycin or linezolid
		E. faecalis should be treated with one of the penicillins
E. coli	Over 20% of gram-negative bacteremia cases are attributed to E. coli infection.	Treat with carbapenems
	Associated mortality is over 15%
Klebsiella species	Klebsiella pneumoniae carbapenemase-producing K. pneumonia, greater than 70% mortality for bacteremic infections	Treat with tigecycline and piperacillin/tazobactam
P. aeruginosa	Declining prevalence secondary to antibiotic coverage	Treat with piperacillin/tazobactam and venous catheter removal recommended
Candida species	Incidence varies widely across studies	Treat with fluconazole. May also offer fluconazole prophylaxis for highest risk patients.
	Patients with acute leukemia are at the highest risk for developing invasive candidiasis during episodes of post-chemotherapy neutropenia
Aspergillus species	Incidence of 4-15% and a mortality of 60-85%	Treat with azoles or caspofungin
HSV-1 and 2	Reactivation present in two-thirds of seropositive patients who undergo induction chemotherapy for acute myeloid leukemia	Treat aggressively with acyclovir
Varicella zoster virus (VZV)	Reactivation of VZV causes herpes zoster in an average of 5 months following the initiation of chemotherapy in lymphoma patients	Prophylactic acyclovir should be considered in patients with an extended duration of low lymphocyte count or long-term steroid use to prevent the poor clinical course associated with visceral disseminated VZV infection.
Community-acquired respiratory viruses	The risk for infection via CARVs mirrors respiratory virus outbreaks in the general population [19]. The degree, duration, and type of immunosuppression at patient are receiving directly correlates to the severity of CARV infections [20].	Supportive care

Table 1. Common Infections in Cancer Patients, Frequency and Treatment

Organism

Frequency

Treatment

S. aureus: Staphylococcus aureus; AML: acute myeloid leukemia; S. agalactiae: Streptococcus agalactiae; S. pneumoniae: Streptococcus pneumoniae; E. faecalis: Enterococcus faecalis; E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; HSV: herpes simplex virus; CARVs: community-acquired respiratory viruses.

S. aureus

Between 1.3% and 12% of bacteremia cases [15]

Methicillin-susceptible S. aureus should be treated with an anti-staphylococcal beta-lactam (i.e., cefazolin or nafcillin).

Nearly 27% of skin and soft tissue infections [14]

Methicillin-resistant S. aureus should be treated with vancomycin.

About 26% of pneumonia cases [14]

Venous catheter removal recommended

Viridans group streptococci

Occurred in about 23% of children with AML being treated with chemotherapy [17]

No well-defined, optimal therapy

S. agalactiae

Accounts for > 80% of recurrent infections following streptococcal bloodstream infections [16]

Treat with penicillins or cephalosporins

S. pneumoniae

Accounts for about 6.5% of episodes of bacteremia [18]

Treat with levofloxacin or vancomycin

Enterococcus species

Disproportionately found in cancer patients; 15-20% are vancomycin resistant.

Vancomycin resistant Enterococcus should be treated with daptomycin or linezolid

E. faecalis should be treated with one of the penicillins

E. coli

Over 20% of gram-negative bacteremia cases are attributed to E. coli infection.

Treat with carbapenems

Associated mortality is over 15%

Klebsiella species

Klebsiella pneumoniae carbapenemase-producing K. pneumonia, greater than 70% mortality for bacteremic infections

Treat with tigecycline and piperacillin/tazobactam

P. aeruginosa

Declining prevalence secondary to antibiotic coverage

Treat with piperacillin/tazobactam and venous catheter removal recommended

Candida species

Incidence varies widely across studies

Treat with fluconazole. May also offer fluconazole prophylaxis for highest risk patients.

Patients with acute leukemia are at the highest risk for developing invasive candidiasis during episodes of post-chemotherapy neutropenia

Aspergillus species

Incidence of 4-15% and a mortality of 60-85%

Treat with azoles or caspofungin

HSV-1 and 2

Reactivation present in two-thirds of seropositive patients who undergo induction chemotherapy for acute myeloid leukemia

Treat aggressively with acyclovir

Varicella zoster virus (VZV)

Reactivation of VZV causes herpes zoster in an average of 5 months following the initiation of chemotherapy in lymphoma patients

Prophylactic acyclovir should be considered in patients with an extended duration of low lymphocyte count or long-term steroid use to prevent the poor clinical course associated with visceral disseminated VZV infection.

Community-acquired respiratory viruses

The risk for infection via CARVs mirrors respiratory virus outbreaks in the general population [19]. The degree, duration, and type of immunosuppression at patient are receiving directly correlates to the severity of CARV infections [20].

Supportive care