Abstract
Objectives
To assess the disease spectrum of Fusobacterium bacteremia in our neutropenic patients and review the literature.
Methods
This was a 6.5-year retrospective study in which all the records of neutropenic patients with Fusobacterium bacteremia were analyzed.
Results
Fusobacterium bacteremia was found in 13 neutropenic patients, 10 with hematological malignancies and 3 with solid tumors. The standard clinical presentation was that of primary bacteremia with benign evolution under antibiotics with anaerobic coverage. Most patients presented with oral mucositis as the probable portal of entry. Coinfection with other germs was documented in four patients. No patient had a localized infection documented. Most patients were receiving ciprofloxacin chemoprophylaxis. None of the patients had catheter-related infection. All tested strains were susceptible to all standard anaerobic agents. Fusobacterium spp. were responsible for 5% of bacteremias in neutropenic patients in our hospital during the last 6.5 years.
Conclusion
Fusobacterium bacteremia is a possible cause of febrile neutropenia, especially in the setting of quinolone prophylaxis and oral mucositis after intense chemotherapeutic regimens. We think that its benign outcome if there is no localized infection detected does not justify the use of antianaerobic prophylaxis. Combination of beta-lactams and beta-lactamase inhibitors is a safe and reasonable treatment.
Similar content being viewed by others
References
Baquero F, Fernandez J, Dronda F, Erice A, Perez de Oteiza J, Reguera JA, Reig M (1990) Capnophilic and anaerobic bacteremia in neutropenic patients: an oral source. Rev Infect Dis 12 [Suppl 2]:S157–S160
Bourgault AM, Lamothe F, Dolce P, Saint-Jean L, Saint-Antoine P (1997) Fusobacterium bacteremia: clinical experience with 40 cases. Clin Infect Dis 25 [Suppl 2]:S181–S183
Brook I (1989) Anaerobic bacterial bacteremia: 12-year experience in two military hospitals. J Infect Dis 160:1071–1075
Brook I, Frazier EH (1998) Aerobic and anaerobic infection associated with malignancy. Support Care Cancer 6:125–131
Cockerill FR 3rd, Hughes JG, Vetter EA, Mueller RA, Weaver AL, Ilstrup DM, Rosenblatt JE, Wilson WR (1997) Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis 24:403–418
Coullioud D, Van der Auwera P, Viot M, Lasset C (1993) Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. CEMIC (French-Belgian Study Club of Infectious Diseases in Cancer). Support Care Cancer 1:34–46
Dorsher CW, Rosenblatt JE, Wilson WR, Ilstrup DM (1991) Anaerobic bacteremia: decreasing rate over a 15-year period. Rev Infect Dis 13:633–636
Elting LS, Rubenstein EB, Rolston KV, Bodey GP (1997) Outcomes of bacteremia in patients with cancer and neutropenia: observations from two decades of epidemiological and clinical trials. Clin Infect Dis 25:247–259
Fainstein V, Elting LS, Bodey GP (1989) Bacteremia caused by non-sporulating anaerobes in cancer patients. A 12-year experience. Medicine (Baltimore) 68:151–162
Finegold SM (1993) A century of anaerobes: a look backward and a call to arms. Clin Infect Dis 16 [Suppl 4]:S453–S457
Finegold S (2000) Anaerobic bacteria: general concepts. In: Mandell G, Douglas RG, Bennet J (eds) Principles and practice of infectious diseases, 5th edn. Churchill Livingstone, London, pp 2519–2537
Gunther G, Bjorkholm M, Bjorklind A, Engervall P, Stiernstedt G (1991) Septicemia in patients with hematological disorders and neutropenia. A retrospective study of causative agents and their resistance profile. Scand J Infect Dis 23:589–598
Henry S, DeMaria A Jr, McCabe WR (1983) Bacteremia due to Fusobacterium species. Am J Med 75:225–231
Huyghebaert MF, Dreyfus F, Paul G, Vedel G, Nati R, Faucher C, Belanger C, Dhainaut JF (1989) Septicemia caused by beta-lactamase producing Fusobacterium nucleatum in a patient with neutropenia. Ann Med Interne (Paris) 140:225–226
Landsaat PM, van der Lelie H, Bongaerts G, Kuijper EJ (1995) Fusobacterium nucleatum, a new invasive pathogen in neutropenic patients? Scand J Infect Dis 27:83–84
Lark RL, Chenoweth C, Saint S, Zemencuk JK, Lipsky BA, Plorde JJ (2001) Risk factors for anaerobic bloodstream infections in bone marrow transplant recipients. Clin Infect Dis 33:338–343
Lorber B (2000) Bacteroides, Prevotella, Porphyromonas and Fusobacterium species (and other medically important anaerobic Gram negative bacilli. In: Mandell G, Douglas RG, Bennet J (eds) Principles and practice of infectious diseases, 5th edn. Churchill Livingstone, London, pp 2561–2570
Noriega LM, Van der Auwera P, Phan M, Daneau D, Meunier F, Gerain J, Aoun M (1993) Anaerobic bacteremia in a cancer center. Support Care Cancer 1:250–255
Schimpff SC (1986) Empiric antibiotic therapy for granulocytopenic cancer patients. Am J Med 80 (5C):13–20
Van der Lelie H, van Ketel RJ, von dem Borne AE, van Oers RH, Thomas BL, Goudsmit R (1991) Incidence and clinical epidemiology of streptococcal septicemia during treatment of acute myeloid leukemia. Scand J Infect Dis 23:163–168
Vidal AM, Sarria JC, Kimbrough RC 3rd, Keung YK (2000) Anaerobic bacteremia in a neutropenic patient with oral mucositis. Am J Med Sci 319:189–190
Weinberger M, Wu T, Rubin M, Gill VJ, Pizzo PA (1991) Leptotrichia buccalis bacteremia in patients with cancer: report of four cases and review. Rev Infect Dis 13:201–206
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB (1997) The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 24:584–602
Acknowledgement
We are indebted to Mrs. Nathalie Cardinal for assistance in the preparation of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fanourgiakis, P., Vekemans, M., Georgala, A. et al. Febrile neutropenia and Fusobacterium bacteremia: clinical experience with 13 cases. Support Care Cancer 11, 332–335 (2003). https://doi.org/10.1007/s00520-003-0452-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-003-0452-x