Bacillus cereus bacteraemia: comparison between haematologic and nonhaematologic patients

Abstract

Bacillus cereus bacteraemia can be severe, especially among patients with haematologic malignancy. We retrospectively reviewed first episodes of true B. cereus bacteraemia (more than one positive bottle plus signs of infection) at our institution between 1997 and 2013 with the aim to compare haematologic versus nonhaematologic patients and analyse episodes with complicated outcome. Among 56 episodes of positive-blood cultures for B. cereus, 21 were considered significant. Median age was 54 years (range 23–82 years). Ten patients (48%) had a haematologic malignancy; all were neutropenic at the time of B. cereus bacteraemia. Nonhaematologic patients were either intravenous drug users (n = 3, 14%), polytraumatized (n = 3, 14%) or had multiple chronic comorbidities (n = 5, 24%). Most episodes were hospital acquired (15, 71%). Sources of bacteraemia were intravascular catheter (n = 11, 52%), digestive tract (n = 6, 29%), drug injection (n = 3, 14%) and wound (n = 1, 5%). Adequate antibiotic therapy was provided to 18 patients (86%) during a median of 17 days (range 2–253 days). The intravascular catheter was removed in eight cases (42%). Three haematologic patients had a complicated course with neurologic complications (meningoencephalitis and cerebral abscesses). Complications appeared to be associated with catheter infection (100% of complicated cases vs. 29% of noncomplicated cases). In conclusion, B. cereus bacteraemia can have a complicated course in a subset of patients, mainly those with haematologic malignancy. Catheter infection may be associated with a worse outcome with frequent neurologic complications.

Bacillus cereus bacteremia with central nervous system involvement: A neuropathological study

“…Compiled with previously-reported clinical and radiological data on patients with positive blood culture for B. cereus collected in our institution from 1999 to 2013 and published elsewhere [4], this case is the fifth hematological patient with involvement of the CNS by B. cereus (Table 1). Four out of the 5 patients presented an AML, confirming the high risk of B. cereus CNS location in this type of disease, as previously reported [3].…”

“…Identification of B. cereus from blood culture was based on Gram staining, colony morphology, and hemolysis on blood agar, positive lecithinase on egg yolk agar or matrix-assisted laser desorption/ionization (MALDI-TOF). Antimicrobial susceptibility testing was performed using disk diffusion and E-test as previously described [4].…”

“…However, it is recognized as a potential pathogen inducing self-limiting emetic or di-arrheal food poisoning [2] or localized infection in immunocompetent patients [1]. B. cereus bacteremia with infection of the central nervous system (CNS) is uncommon and has mostly been reported in patients with hematological malignancies [3,4,5]. This report describes the clinical, radiological, and pathological features of a fatal disseminated B. cereus infection with CNS involvement.…”

“…This report describes the clinical, radiological, and pathological features of a fatal disseminated B. cereus infection with CNS involvement. The clinical and radiological data are compared to those of a published series of 21 patients from our institution with B. cereus bacteremia [4].…”

Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study

“…Bacillus Cereus was identified as causative microorganism for meningitis leading to fatal outcomes. 17,18 The inability to remove the spores with alcohol might pose a risk in these patients and disinfection procedures with the use of solutions containing chlorine or hydrogen peroxide should be considered…”