Clinical characteristics and antimicrobial susceptibilities of viridans streptococcal bacteremia during febrile neutropenia in patients with hematologic malignancies: a comparison between adults and children

Abstract

BackgroundThis study was performed to compare the clinical characteristics and antibiotic susceptibilities of viridans streptococcal bacteremia (VSB) between febrile neutropenic adults and children with hematologic malignancies.MethodsThe consecutive medical records of neutropenic patients with hematologic malignancies who were admitted to the Catholic Blood and Marrow Transplantation Center between April 2009 and July 2012, and who were subsequently diagnosed with VSB were reviewed retrospectively. A comparison was made between the clinical and laboratory characteristics of adults and pediatric patients and also between patients with cefepime susceptible or not susceptible VSB.ResultsA total of 202 episodes (141 in adults, 61 in children) of VSB were identified. Among them, 26 (12.9%) cases had severe complications including four (2.0%) cases of death attributable to VSB. For antibacterial prophylaxis, most adults received ciprofloxacin (97.1%), but children more frequently received trimethoprim/sulfamethoxazole (86.9%). Oral mucositis (p = 0.005) and abdominal pain (p = 0.001) were found more frequently in adults, and cough was found more frequently in children (p = 0.004). The occurrence rates of severe complications and death attributable to VSB were not significantly different between adults and children. Susceptibility rate to cefepime was significantly higher in adults than children (85.7% vs. 66.1%, p = 0.002). However, in multivariate analysis, cefepime susceptibility had no impact on clinical outcome.ConclusionsThere was no significant difference in clinical outcome between adults and children with VSB despite a difference in cefepime susceptibility. Hence, different antibiotic treatment strategies may not be necessary.

Risk Factors for Viridans Group Streptococcal Bacteremia in Neutropenic and Non-neutropenic Patients: A Single Center Case-Case-Control Study

“…This finding supports the continued practice of using vancomycin as empirical therapy for VGS bacteremia in neutropenic patients. Fewer than 75% of isolates in both groups were fully susceptible to penicillin, in accord with the literature that penicillin susceptibility can no longer be assumed in VGS, with reduced susceptibility reported to be as high as 60% in some reports [20]. …”

Bloodstream infections in neutropenic cancer patients: A practical update

“…Indeed, VGS bacteremia can be complicated by an acute respiratory distress syndrome (ARDS) in 18-39% of cases, with a mortality rate of 20%. [67][68][69] Usually enterococcal BSIs are related to poor underlying clinical conditions, and their direct impact on mortality is unclear 70,71 In some centers, infections with VRE strains have been associated with a higher mortality rate than in case of susceptible strains (33-79%). 58,72 However, the role of resistance to vancomycin in increasing the mortality of enterococcal infections remains elusive.…”

Caracterización clínica y microbiológica de episodios de bacteriemia por Streptococcus grupo viridans en niños con cáncer y neutropenia febril de alto riesgo

“…Las infecciones por estos agentes han requerido atención en esta población por la gravedad del cuadro clínico, que en ocasiones se expresa como síndrome de shock asociado a SGV, determinando hospitalizaciones en Unidades de Paciente Crítico y letalidad 6 . Actualmente, existen reportes de aumento de la resistencia a antimicrobianos en las especies incluídas dentro de SGV, particularmente a β-lactámicos como penicilinas y cefalosporinas, generando debate respecto a la decisión de terapia empírica que incluya glicopéptidos en este tipo de infecciones 7 .…”