There should be no ESKAPE for febrile neutropenic cancer patients: the dearth of effective antibacterial drugs threatens anticancer efficacy

The success of modern anticancer treatment is a composite function of enhanced efficacy of surgical, radiation and systemic treatment strategies and of our collective clinical abilities in supporting patients through the perils of their cancer journeys. Despite the widespread availability of antibacterial therapies, the threat of community- or healthcare facility-acquired bacterial infection remains a constant risk to patients during this journey. The rising prevalence of colonization by multidrug-resistant (MDR) bacteria in the population, acquired through exposure from endemic environments, antimicrobial stewardship and infection prevention and control strategies notwithstanding, increases the likelihood that such organisms may be the cause of cancer treatment-related infection and the likelihood of antibacterial treatment failure. The high mortality associated with invasive MDR bacterial infection increases the likelihood that many patients may not survive long enough to reap the benefits of enhanced anticancer treatments, thus threatening the societal investment in the cancer journey. Since cancer care providers arguably no longer have, and are unlikely to have in the foreseeable future, the antibacterial tools to reliably rescue patients from harms way, the difficult ethical debate over the risks and benefits of anticancer treatments must now be reopened.