High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia

Abstract

Twenty-nine adult patients with acute myelogenous leukemia AML who received 40 treatment courses with high dose cytosine arabinoside (HD-A), alone or combined with other cytotoxic drugs, for remission induction (RI) or postremission intensive consolidation (IC) were retrospectively analysed for types and severity of infectious complications. In this paper, we report the unusually high rate of streptococcal septicemia in our patients. Of 13 bacteremic infections in a total of 45 infectious episodes, 10 were caused by streptococci (9 viridans streptococci, 1 group B hemolytic streptococcus). Three of them were lethal. After reviewing all documented cases of streptococcal septicemia in the same study period, four additional cases among adult patients with AML were identified. Three of them have had antileukemic chemotherapy without HD-A, while one have had HD-A as a conditioning regimen for bone marrow transplantation. Only three cases were documented to occur in adult patients with AML. Patients treated with HD-A for RI or IC had a significantly lower risk of streptococcal septicemia during previous chemotherapy-associated febrile neutropenic episodes (1/55 vs 10/45; P = 0.01). Neither prophylactic regimens including trimethoprim-sulfamethoxazole nor those without it were effective in preventing streptococcal septicemia. Further studies are needed to confirm these data before the value of additional or alternative prophylactic antibiotics is proven necessary.

Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia

“…There were 3 major differences between the 2 regimens that might explain these findings, namely, the presence of fludarabine, higher daily dose of idarubicin, and higher daily dose of cytarabine associated with the fludarabine-based regimen (although the cumulative doses of idarubicin and cytarabine were similar). Given previous reports that have found that high-dose cytarabine is a risk factor for invasive viridans group streptococcal infections, [8][9][10][11][12][13] it seems that the latter may be the more likely etiologic factor behind worse infection outcomes associated with the fludarabine regimen.…”

Antimicrobial susceptibilities of Streptococcus species that cause septicemia in neutropenic patients

“…Viridans group streptococci are the most frequent isolates (6,7); in our center in resent years, these organisms have represented the leading cause of septicemia, exceeded only by coagulase-negative staphylococci. The response to empiric antibiotics is usually favorable (3,(6)(7)(8). However, the clinical presentation may include septic shock, adult respiratory distress syndrome, and encephalopathy without meningitis (6,7,10).…”

“…Streptococcal septicemia is a growing problem among patients undergoing intensive cytoreductive chemotherapy (2,3,7,8). At particular risk of infection seem to be patients receiving high doses of cytosine arabinoside or allogeneic bone marrow transplantation for acute lymphocytic leukemia (6,7).…”

“…At particular risk of infection seem to be patients receiving high doses of cytosine arabinoside or allogeneic bone marrow transplantation for acute lymphocytic leukemia (6,7). Viridans group streptococci are the most frequent isolates (6,7); in our center in resent years, these organisms have represented the leading cause of septicemia, exceeded only by coagulase-negative staphylococci. The response to empiric antibiotics is usually favorable (3,(6)(7)(8).…”

Ceftazidime as monotherapy or combined with teicoplanin for initial empiric treatment of presumed bacteremia in febrile granulocytopenic patients

“…Selective oral prophylaxis has reduced the incidence of gram-negative infections (3,12), while bacteremia caused by coagulase-negative staphylococci has increased, partly as a result of the greater use of indwelling intravenous catheters (6,21). Intensification of cytostatic therapy has resulted in extensive damage to the mucosa, particularly of the mouth; consequently, bacteremia caused by viridans group streptococci has assumed greater prominence (2,13). Thus, agents specific for gram-positive bacteria, particularly vancomycin, are often added to the initial regimen when fever persists (17) or are included in the initial empiric regimen (18).…”