Skip to main content

Advertisement

SpringerLink
Log in

Viridans group streptococci bloodstream infections in neutropenic adult patients with hematologic malignancy: Single center experience

  • Original Article
  • Published:
Folia Microbiologica Aims and scope Submit manuscript

Abstract

Viridans group streptococci bloodstream infections (VGS BSI) remain a significant cause of mortality and morbidity in patients with severe neutropenia. The goal of our study was to evaluate clinical course and microbiological susceptibility of VGS BSI at our center. Retrospective analysis of all microbiologically documented bloodstream infections caused by VGS during the 9-year time period (from January 2006 until December 2014) was carried out. Only patients with severe neutropenia (< 500/μL) were included in the study. Clinical outcome and microbiological susceptibility pattern of isolates were recorded. Fifty-one individual patients with episode of VGS BSI were identified. The most frequent agent was Streptococcus mitis (23/51 cases, 45.1%). 88.2% (45/51) of patients were on recommended ciprofloxacin prophylaxis. 20/51 (39.2%) of patients suffered from mucositis at the time of diagnosis (10 patients had oral mucositis, 2 patients had bowel mucositis, and 8 patients both). Twenty-six patients (51.0%) had clinically relevant lung damage caused by VGS BSI (i.e., acute lung injury or acute respiratory distress syndrome). Twenty-four (47.0%) patients presented with bilateral lung infiltrated upon chest imaging, and two (4.0%) patients had unilateral lung infiltrates. Three patients (5.9%) died due to VGS BSI until day 28 of observation. No difference in signs of shock syndrome was observed in the patients during transplantation procedures compared to patients without transplantation as well as in a group received previous high-dose chemotherapy with cytosinarabinoside or in patients with mucositis. Only 3/51 of isolates (5.9%) were resistant to penicillin. All isolates were susceptible to empirical treatment. While the penicillin resistance of VGS remains low in middle Europe, initial antibiotic therapy of febrile neutropenia are still effective in most cases. The mortality and complication rates of VGS BSI were comparable to other studies, and no specific risk factor of shock presence could be identified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aust C, Tolfvenstam T, Broliden K et al (2013) Bacteremia in Swedish hematological patients with febrile neutropenia: bacterial spectrum and antimicrobial resistance patterns. Scand J Infect Dis 45:285–291. doi:10.3109/00365548.2012.735372

    Article  PubMed  Google Scholar 

  • Carratalá J, Alcaide F, Fernández-Sevilla A et al (1995) Bacteremia due to viridans streptococci that are highly resistant to penicillin: increase among neutropenic patients with cancer. Clin Infect Dis 20:1169–1173

    Article  PubMed  Google Scholar 

  • Cattaneo C, Casari S, Bracchi F et al (2010) Recent increase in enterococci, viridans streptococci, Pseudomonas spp. and multiresistant strains among haematological patients, with a negative impact on outcome. Results of a 3-year surveillance study at a single institution. Scand J Infect Dis 42:324–332. doi:10.3109/00365540903496569

    Article  PubMed  Google Scholar 

  • Elting LS, Bodey GP, Keefe BH (1992) Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis 14:1201–1207

    Article  CAS  PubMed  Google Scholar 

  • Engelhard D, Elishoov H, Or R et al (1995) Cytosine arabinoside as a major risk factor for Streptococcus viridans septicemia following bone marrow transplantation: a 5-year prospective study. Bone Marrow Transplant 16:565–570

    CAS  PubMed  Google Scholar 

  • Freifeld AG, Bow EJ, Sepkowitz KA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:e56–e93. doi:10.1093/cid/cir073

    Article  PubMed  Google Scholar 

  • Gassas A, Grant R, Richardson S et al (2004) Predictors of viridans streptococcal shock syndrome in bacteremic children with cancer and stem-cell transplant recipients. J Clin Oncol 22:1222–1227. doi:10.1200/JCO.2004.09.108

    Article  PubMed  Google Scholar 

  • Ghaffar F, Friedland IR, Katz K et al (1999) Increased carriage of resistant non-pneumococcal alpha-hemolytic streptococci after antibiotic therapy. J Pediatr 135:618–623

    Article  CAS  PubMed  Google Scholar 

  • Gordon KA, Beach ML, Biedenbach DJ et al (2002) Antimicrobial susceptibility patterns of beta-hemolytic and viridans group streptococci: report from the SENTRY Antimicrobial Surveillance Program (1997–2000). Diagn Microbiol Infect Dis 43:157–162

    Article  CAS  PubMed  Google Scholar 

  • Han SB, Bae EY, Lee JW et al (2013a) Clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia in children with febrile neutropenia. Infection 41:917–924. doi:10.1007/s15010-013-0470-7

    Article  CAS  PubMed  Google Scholar 

  • Han SB, Bae EY, Lee JW et al (2013b) Clinical characteristics and antimicrobial susceptibilities of viridans streptococcal bacteremia during febrile neutropenia in patients with hematologic malignancies: a comparison between adults and children. BMC Infect Dis 13:273. doi:10.1186/1471-2334-13-273

    Article  PubMed  PubMed Central  Google Scholar 

  • Husain E, Whitehead S, Castell A et al (2005) Viridans streptococci bacteremia in children with malignancy: relevance of species identification and penicillin susceptibility. Pediatr Infect Dis J 24:563–566

    Article  PubMed  Google Scholar 

  • Jaffe D, Jakubowski A, Sepkowitz K et al (2004) Prevention of peritransplantation viridans streptococcal bacteremia with early vancomycin administration: a single-center observational cohort study. Clin Infect Dis 39:1625–1632. doi:10.1086/425612

    Article  CAS  PubMed  Google Scholar 

  • Marron A, Carratalà J, González-Barca E et al (2000) Serious complications of bacteremia caused by Viridans streptococci in neutropenic patients with cancer. Clin Infect Dis 31:1126–1130. doi:10.1086/317460

    Article  CAS  PubMed  Google Scholar 

  • Piukovics K, Terhes G, Lázár A et al (2015) Evaluation of bloodstream infections during chemotherapy-induced febrile neutropenia in patients with malignant hematological diseases: single center experience. Eur J Microbiol Immunol 5:199–204. doi:10.1556/1886.2015.00021

    Article  Google Scholar 

  • Raber-Durlacher JE, Laheij AMGA, Epstein JB et al (2013) Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study. Support Care Cancer 21:1621–1627. doi:10.1007/s00520-012-1706-2

    Article  PubMed  Google Scholar 

  • Reilly AF, Lange BJ (2007) Infections with viridans group streptococci in children with cancer. Pediatr Blood Cancer 49:774–780. doi:10.1002/pbc.21250

    Article  PubMed  Google Scholar 

  • Ruescher TJ, Sodeifi A, Scrivani SJ et al (1998) The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies. Cancer 82:2275–2281

    Article  CAS  PubMed  Google Scholar 

  • Shelburne SA, Lasky RE, Sahasrabhojane P et al (2014a) Development and validation of a clinical model to predict the presence of β-lactam resistance in viridans group streptococci causing bacteremia in neutropenic cancer patients. Clin Infect Dis 59:223–230. doi:10.1093/cid/ciu260

    Article  CAS  PubMed  Google Scholar 

  • Shelburne SA, Sahasrabhojane P, Saldana M et al (2014b) Streptococcus mitis strains causing severe clinical disease in cancer patients. Emerg Infect Dis 20:762–771. doi:10.3201/eid2005.130953

    Article  PubMed  PubMed Central  Google Scholar 

  • Shenep JL (2000) Viridans-group streptococcal infections in immunocompromised hosts. Int J Antimicrob Agents 14:129–135

    Article  CAS  PubMed  Google Scholar 

  • Spanik S, Trupl J, Kunova A et al (1997) 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. Scand J Infect Dis 29:245–249

    Article  CAS  PubMed  Google Scholar 

  • Tunkel AR, Sepkowitz KA (2002) Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis 34:1524–1529. doi:10.1086/340402

    Article  PubMed  Google Scholar 

  • Westling K, Julander I, Ljungman P et al (2004) Reduced susceptibility to penicillin of viridans group streptococci in the oral cavity of patients with haematological disease. Clin Microbiol Infect 10:899–903. doi:10.1111/j.1469-0691.2004.00975.x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The work was supported by the project PROGRES Q40/08 (Charles University, Faculty of Medicine in Hradec Králové) and by the Czech Health Research Council, Ministry of Health of the Czech Republic, grant no. 17-28539A.

Author information

Authors and Affiliations

  1. 4th Department of Internal Medicine – Haematology, University Hospital Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic

    J. Radocha, A. Zavřelová, B. Víšek, F. Gabalec & P. Žák

  2. Institute of Clinical Microbiology, University Hospital Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic

    P. Paterová & H. Žemličková

Authors
  1. J. Radocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Paterová
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Zavřelová
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Víšek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Gabalec
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Žemličková
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Žák
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JR wrote the manuscript and collected and reviewed the clinical data.

AZ collected and reviewed the clinical data and reviewed the manuscript.

PP wrote the manuscript and collected and reviewed the microbiological and susceptibility data.

BV reviewed the manuscript.

FG reviewed and approved the manuscript.

HZ reviewed and approved the manuscript.

PZ reviewed and approved the manuscript.

Corresponding author

Correspondence to J. Radocha.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Radocha, J., Paterová, P., Zavřelová, A. et al. Viridans group streptococci bloodstream infections in neutropenic adult patients with hematologic malignancy: Single center experience. Folia Microbiol 63, 141–146 (2018). https://doi.org/10.1007/s12223-017-0542-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12223-017-0542-7

Search

Navigation