Classic Microbiology Gramnegative Organisms Recent Emergence Of Grampositive Organisms

Landmark papers on fever and neutropenia cited organisms such as E. coli, Klebsiella, and Pseudomonas as major pathogens,2 presumed to originate from the patient's own intestinal flora. However, there has been a shift toward Gram-positive organisms, which now constitute the majority of positive blood culture isolates. Reasons cited for this include use of indwelling i.v. catheters, oral mucositis from current chemotherapy regimens, and use of quinolone prophylaxis.5 Catheters are most likely to become infected with cutaneous flora; oral mucositis predisposes to viridans streptococcal infection, which can be fulminant.6 Quinolones are powerful agents against aerobic Gram-negative bacilli, and may lead to overgrowth of organisms such as staphylo-cocci, streptococci, and enterococci.

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