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Outcomes of neutropenic hemato-oncological patients with viridans group streptococci (VGS) bloodstream infection based on penicillin susceptibility

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Abstract

Viridans group streptococci (VGS) bloodstream infection (BSI) in neutropenic patients can be a severe complication. A higher prevalence of vancomycin use has been reported due to reduced susceptibility to penicillin. We aimed to assess the impact on mortality of both penicillin minimal inhibitory concentration (MIC) and the use of vancomycin. We conducted a retrospective multicenter study including consecutive neutropenic patients with VGS BSI between 2007 and 2019. Univariable and multivariable analyses were conducted to evaluate risk factors for mortality, including penicillin susceptibility as an independent variable. Non-susceptibility to penicillin was defined as MIC ≥ 0.25. We included 125 neutropenic patients with VGS BSI. Mean age was 53 years and ~ 50% were women. Overall, 30-day mortality rate was 25/125 (20%), and 41 patients (33%) had a VGS isolate non-susceptible to penicillin. In univariable analysis, no significant association was demonstrated between penicillin non-susceptibility and mortality (9/25, 26% vs. 32/100, 32%, p = 0.81). Among patients with a non-susceptible strain, the use of vancomycin was not significantly associated with mortality (empirical, p = 0.103, or definitive therapy, p = 0.491). Factors significantly associated with increased mortality in multivariable analysis included functional status (ECOG > 1, adjusted odds ratio [aOR] 12.53, 95% CI 3.64–43.14; p < 0.0001); allogeneic transplantation (aOR 6.33, 95% CI 1.96–20.46; p = 0.002); and co-pathogen in blood cultures (aOR 3.99, 95% CI 1.34–11.89; p = 0.013). Among neutropenic hemato-oncological patients with VGS BSI, penicillin non-susceptibility and the use of vancomycin were not associated with mortality. Thus, vancomycin should not be used routinely as empirical therapy in neutropenic patients with suspected VGS BSI.

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Author notes

  1. Oryan Henig and Dafna Yahav contributed equally to this work.

Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Liat Shargian, Pia Raanani, Haim Ben-Zvi, Oryan Henig & Dafna Yahav

  2. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel

    Liat Shargian & Pia Raanani

  3. Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel

    Mical Paul

  4. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel

    Mical Paul & Tal Nachshon

  5. Medicine C, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Gida Ayada

  6. Infectious Disease Institute, Soroka University Medical Center, Beer Sheva, Israel

    Lior Nesher

  7. The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Lior Nesher

  8. Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel

    Haim Ben-Zvi

  9. Infection Prevention Unit, Division of Infection Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

    Oryan Henig

  10. Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel

    Dafna Yahav

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  1. Liat Shargian
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Correspondence to Oryan Henig.

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This study was approved by the local ethical committee of both Rabin Medical Center and Rambam Health Care Campus.

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Shargian, L., Paul, M., Nachshon, T. et al. Outcomes of neutropenic hemato-oncological patients with viridans group streptococci (VGS) bloodstream infection based on penicillin susceptibility. Eur J Clin Microbiol Infect Dis 42, 177–182 (2023). https://doi.org/10.1007/s10096-022-04533-1

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