Septicaemia Caused by Viridans Streptococci in Neutropenic Patients With Leukaemia

Cohen, Jonathan; Worsley, A. M.; Goldman, JM; Donnelly, J. Peter; Catovsky, Daniel; Galton, D. A. G.

doi:10.1016/s0140-6736(83)90799-7

Cited by 179 publications

(58 citation statements)

References 5 publications

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“…The incidence of S. viridans bacteremia following allogeneic BMT has ranged from 0 to 46.2%. [8][9][10][11] Furthermore, in several other series of patients undergoing both allogeneic and autologous BMT, the incidence has varied from 9 to 28.6%. 5,[12][13][14][15] The most frequently isolated subtypes of S. viridans have been S. sanguis and S. mitis, accounting for 75% of isolates in one large series.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

Bilgrami

Feingold

Dorsky

et al. 1998

Bone Marrow Transplant

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Summary:A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation was conducted to ascertain the incidence and outcome of Streptococcus viridans bacteremia as well as to determine the role of prophylactic ampicillin therapy in the peri-transplant setting. Viridans streptococci were isolated from the blood of 35 individuals at a median of 6 days (range 2-8 days) following stem cell infusion. The most common isolates were S. sanguis and S. mitis. All patients received ciprofloxacin orally during the peritransplant period. Additionally, 79 patients received oral ampicillin prophylactically against gram-positive cocci. Although none of the patients suffered a fatal outcome, three individuals developed respiratory compromise requiring mechanical ventilation. Female sex proved to be the only independent risk factor for viridans streptococcal bacteremia (P = 0.04). The shorter duration of neutropenia observed after stem cell transplantation did not impact on the incidence of S. viridans infections. Moreover, the prophylactic use of ampicillin failed to decrease the incidence of viridans sepsis and selected out organisms that were resistant to betalactam antibiotics. Keywords: Streptococcus viridans; autologous stem cell transplantation Gram-positive cocci are the most commonly isolated bacteria following allogeneic and autologous bone marrow transplantation (BMT). Streptococcus viridans is identified frequently and can result in significant morbidity and occasional mortality. A recent trend has been the increased utilization of autologous peripheral blood stem cell transplantation (PBSCT) in combination with growth factors. This has resulted in a significant reduction in the duration of neutropenia with the potential for fewer early bacterial infections. We evaluated the incidence and outcome of S. viridans bacteremia in 200 consecutive recipients of autologous PBSCT for a variety of solid tumors (ST) and hematologic malignancies (HM).

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Section: Discussionmentioning

confidence: 99%

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

Bilgrami

Feingold

Dorsky

et al. 1998

Bone Marrow Transplant

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“…38 However, the prevalence of an oral focus in febrile septicaemia has been reported in 25-50%. 10,[39][40][41] Mucositis in the oral cavity predisposes neutropenic cancer 10,42 Streptococcus oralis and Streptococcus mitis are the two most common isolates from blood cultures and both are normal residents in the oral cavity. 43 Streptococcus viridans isolation in blood cultures is associated closely with the onset of oral mucositis.…”

Section: Pathophysiologymentioning

confidence: 99%

Prophylaxis and treatment of chemo- and radiotherapy-induced oral mucositis – are there new strategies?

Karthaus

Rosenthal

Ganser

1999

Bone Marrow Transplant

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Summary:Oral mucositis is a major dose-limiting toxic effect of intensive cancer chemotherapy. Oral complications may lead to dose reduction or delay in further cancer treatment. Mucositis can be caused directly by cytotoxic effects and indirectly by sustained neutropenia after cytostatic therapy. An impaired mucosal barrier predisposes to life-threatening septic complications during aplasia. The prevalence of an oral focus in febrile neutropenia has been reported in up to 30% of cases and also reduces quality of life. The basic strategies aim at pain relief and prevention of bacterial and fungal infectious complications. However, no effective causal prophylaxis or treatment of oral mucositis is widely accepted. The introduction of cytokines, eg granulocytemacrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) for oral mucositis may be particularly effective and offer a new and hopeful approach. At present, the optimal growth factor, best schedule, effective dosage and best mode of application is not known.

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“…chemotherapy and radiotherapy [4]3 and the widespread use of oral antibacterial prophylaxis which has reduced the inci dence of gram-negative infections [5]. Since there are no reliable clinical means of distinguishing between patients with fever due to a potentially life-threatening infection from those at lesser risk3 empirical antimicrobial regimens must provide adequate cover against gram-negative infections as these can prove rapidly fatal.…”

mentioning

confidence: 99%

Early identification of neutropenic patients at risk of gram-positive bacteraemia and the impact of empirical administration of vancomycin

Dompeling

Donnelly

Deresinski

et al. 1996

European Journal of Cancer

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The aim o f this m ulticentre randomised trial was to determine whether it was possible to predict grampositive bacteraem ia, and whether the em pirical use o f vancomycin would lead to reduced morbidity and mortality. 35 o f 113 patients (31%; confidence interval. Cl 8.5), who presented with a skin or soft tissue infection and had received empirical vancomycin in addition to either ceftazidime or piperacillin-tobram ycin, had initial bacteraemia with a single gram-positive bacterium compared with 135 of the 784 (17%; C l 2.6), who presented with another infection and who had been given ceftazidime or piperacillin-tobram ycin without vancomycin (P<0.G01). Empirical vancomycin resulted in a higher rate of eradication (P = 0.033, relative risk 1.2), but not a better clinical outcome and was associated with more toxicity (P=0.042, relative risk 1.6). Irrespective of the initial treatment regimen, fever lasted an average of 8 days, the em pirical regimen was modified in more than 50% of cases and mortality attributed to gram-positive infection was less than 2%. Incorporating vancomycin in the initial em pirical antibiotic regimen for febrile neutropenic patients does not appear necessary, even for skin and soft tissue infections associated with gram -positive bacteraemia.

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Septicaemia Caused by Viridans Streptococci in Neutropenic Patients With Leukaemia

Cited by 179 publications

References 5 publications

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

Prophylaxis and treatment of chemo- and radiotherapy-induced oral mucositis – are there new strategies?

Early identification of neutropenic patients at risk of gram-positive bacteraemia and the impact of empirical administration of vancomycin

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