Viridans Group Streptococcal Infections in Children After Chemotherapy or Stem Cell Transplantation

Abstract

Viridans Group Streptococci (VGS) are associated with high mortality rates in febrile neutropenia; yet there are no recent European pediatric studies to inform antimicrobial therapy. The aim of this study was to describe the characteristics, outcome, and resistance patterns of children with VGS bacteremia (VGSB) undergoing treatment of malignancy or hematopoietic stem cell transplant.Patients aged 0 to 18 years, admitted to a tertiary pediatric hemato-oncology center with VGSB, from 2003 to 2013, were included in the study. All data were collected retrospectively from medical records.A total of 54 bacteremic episodes occurred in 46 patients. The most common underlying diagnosis was relapsed acute lymphoblastic leukemia.Streptococcus mitis was the most frequent organism. A total of 30% of isolates were resistant to penicillin and 100% sensitive to vancomycin. There were 8 episodes (14.8%) of Viridans Group Streptococcal Shock Syndrome; 6 resulted in admission to intensive care and 3 of these patients died of multiorgan failure.The potentially fatal nature of VGSB is confirmed. The high risk in relapsed acute lymphoblastic leukemia is of note. Research is needed to develop risk-stratification scores that identify children at risk of Viridans Group Streptococcal Shock Syndrome to guide empirical antimicrobial therapy in febrile neutropenia.

Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014

“…Intensive chemotherapy increases this risk by causing neutropenia and defects in mucosal barriers such as mucositis (Al-Mulla et al, 2014;Johannsen et al, 2013). Defects in mucosal barriers of the gastrointestinal tract increase the risk of infection by bacteria that normally colonize the gastrointestinal tract (Johannsen et al, 2013;Nielsen et al, 2016).…”

Bloodstream infection by multidrug‐resistant Streptococcus oralis in a leukemic patient with febrile neutropenia after hematopoietic stem cell transplantation

“…When the isolate showed a penicillin MIC ≥4 μg/mL, more than two‐third of isolates showed nonsusceptible to ceftriaxone, cefepime, and meropenem . About 30% of isolated VGS in blood culture from the patients with pediatric malignancy were reported to be resistant to penicillin . A 17% of isolated VGS in blood culture showed a penicillin MIC ≥2 μg/mL.…”

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

“…En cuanto al patrón de resistencia a antimicrobianos, en esta serie que reúne un amplio período de seguimiento (14 años) no se logró establecer un incremento de resistencia a antimicrobianos de interés para el tratamiento de estos pacientes. Sin embargo, destaca el alto y sostenido porcentaje de resistencia a penicilina, que oscila entre 43 y 71%, fenómeno descrito por diversos grupos [16][17][18] . Al respecto, Shelburne y cols., desarrollaron un modelo de predicción de resistencia a β lactámicos, detectando como variables significativas el empleo de algún β lactámico como profilaxis o tratamiento en los 30 días precedentes o el inicio de bacteriemia por SGV mientras el paciente estaba hospitalizado.…”