Viridans Streptococcal Bacteraemia Due to Penicillin-Resistant and Penicillin-Sensitive Streptococci: Analysis of Risk Factors and Outcome in 60 Patients from a Single Cancer Centre Before and After Penicillin is Used for Prophylaxis

Abstract

60 patients with 60 viridans streptococcal bacteraemic episodes (42 due to penicillin-sensitive and 18 due to penicillin-resistant viridans streptococci) were analysed in a population of 12,185 admissions and 1,380 bacteraemic episodes during a 7-year period in a National Cancer Institute. The incidence of viridans streptococci among bacteraemias decreased from 11.5% in 1989 to 2.5% in 1995 after penicillin was introduced for prophylaxis of febrile neutropenia in acute leukaemia in 1993. However, the proportion of penicillin-resistant viridans streptococcal bacteraemias increased from 0 in 1989 and 1990 before any prophylaxis was given, to 12.9-16.7% after quinolones were used for prophylaxis in 1991 and 1992, and to 44.4-81.8% in 1993-1995 after penicillin was added to the quinolones. Mortality rate was higher in the subgroup of penicillin-resistant viridans streptococcal bacteraemias (p < 0.05). Statistically significant risk factors in patients with penicillin-resistant (compared with penicillin-sensitive) viridans streptococcal bacteraemia were: acute leukaemia (p < 0.03), high doses of cytarabine (p < 0.05), mucocutaneous lesions (p < 0.004), breakthrough bacteraemia during prophylaxis with ofloxacine plus penicillin (p < 0.001). Multiple logistic regression analysis showed that only acute leukaemia (OR 2.05, CI 0.85-1.85, p < 0.00452) and penicillin-resistance (OR 0.71, CI 0.103-4.887, p < 0.0209) were significant independent predictors of inferior outcome. Breakthrough bacteraemia during empiric therapy with vancomycine occurred in 5 of 116 patients treated with vancomycine, and during therapy with ampicillin plus gentamicin in 6 patients of 18 treated.

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

“…The 12.9% occurrence rate of severe complications attributable to VSB was lower than that of previous reports, which showed an occurrence rate of 18-39%, and the 2.0% mortality attributable to VSB in this study was also lower than that of previous reports, which showed mortality up to 20% [8-10]. Although Martino et al [11] reported a higher occurrence rate of severe complications and death due to VSB in children than in adults, the occurrence rate of severe complications and death attributable to VSB and overall mortality were not significantly different between adults and children in the present study.…”

“…Viridans streptococcal bacteremia (VSB) has been reported to cause severe complications such as shock and acute respiratory distress syndrome (ARDS) in 18-39% of infected neutropenic patients and death in up to 20% [8-10]. A higher occurrence rate of these severe complications was reported in children compared to adults [11].…”

Antimicrobial Susceptibility Patterns among Viridans Group Streptococcal Isolates from Infective Endocarditis Patients from 1971 to 1986 and 1994 to 2002

“…There have been previous reports of viridans group streptococci for which vancomycin MICs were slightly elevated (3,23,25,27).…”

Infective Endocarditis Due to Penicillin-Resistant Viridans Group Streptococci

“…To date, patients with cancer have been largely impacted by these more-resistant isolates [8][9][10][11][12]. In contrast, only a limited number of penicillinresistant isolates have been described as causes of infective endocarditis [13][14][15][16][17][18][19][20][21][22].…”