Febrile Neutropenia
Emerging Pathogens
Vancomycin Resistant Enterococci (VRE)
VRE has been a concern in an era where some institutions have been using more commonly vancomycin or teicoplanin as part of an empiric regimen protocol. Other risk factors include duration of neutropaenia and antibiotic therapy, with ceftazidime or amikacin in particular 39.
Outbreaks with VRE have been described in paediatric oncology units with associated deaths 40. Patient to patient transmission on an oncology unit is an important recognised factor in the development of outbreaks. Therefore, barrier isolation associated with a restricted used of glycopeptides have been key in decreasing colonization of patients at risk 39,41.
The emergence of VRE also illustrates the difficulty of trading off the risk to the individual patient and society (or at least the oncology unit). A balance is required to give maximal benefit of broad spectrum coverage to the individual and the wider benefit to the unit as a whole, by limiting the use of unnecessary agents and therefore avoid the spread of organisms such as VRE.
