Practice Lesson of the Week

Colonic carcinoma presenting as repeated episodes of enterobacter septicaemia during induction of remission in acute myeloblastic leukaemia

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4027 (Published 02 November 2009) Cite this as: BMJ 2009;339:b4027
  1. Bassam Odeh, associate specialist1,
  2. David Bareford, consultant haematologist2
  1. 1Department of Haematology, City Hospital, Birmingham B18 7QH
  2. 2Department of Haematology, Russells Hall Hospital, Dudley DY1 2HQ
  1. Correspondence to: D Bareford, Department Haematology, Russells Hall Hospital, Dudley DY1 2HQ d.bareford{at}bham.ac.uk
  • Accepted 3 November 2008

During neutropenic episodes, recurrent septicaemia with gut bacteria should prompt suspicion of underlying gut pathology

Patients undergoing curative treatment for acute leukaemia receive several cycles of combination chemotherapy using intravenous cytotoxic drugs given through central venous catheters. As a side effect, each period of treatment is followed by a pancytopenic phase lasting between two and four weeks, when haemoglobin, white cells, and platelets reach very low levels. During this period transfusions of blood and platelets are needed. If the patient becomes pyrexial (neutropenic fever) blood cultures are taken and broad spectrum antibiotics are started while awaiting specific identification of the cultured organism and its sensitivity to antibiotics. Over the past two decades the most common organisms isolated have been Gram positive bacteria, often in relation to the use of central venous catheters.1 Staphylococcus epidermidis is frequently isolated and responds to vancomycin or teicoplanin. Repeated isolation of Gram positive organisms in blood culture often leads to removal of the central line with resolution of the problem. Repeated blood cultures positive for Gram negative organisms are very rare. We report a case in which repeated isolation of a Gram negative organism commonly found …

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