Antifungal antibiotics and breakthrough bacteremias

Patients with fever and neutropenia are at high risk for infection (∼50%) and bacteremia (∼20%). As a result, most are treated with antibacterial prophylaxis until their absolute neutrophil count exceeds 500 cells/mm³and their temperature returns to normal. The 1997 guidelines of the Infectious Diseases Society of America suggested 1 of 3 regimens: vancomycin plus ceftazidime, monotherapy with ceftazidime or imipenem (possibly cefepime or meropenem), or dual therapy with an aminoglycoside plus an antipseudomonal β-lactam [1].