Stomatococcus mucilaginosus septicemia in leukemic patients

Abstract

OBJECTIVE: To report an unexpectedly high number of cases of septicemia with Stomatococcus mucilaginosus, and try to identify predisposing factors. METHODS: All blood cultures obtained during 1991--93 from patients treated at the hematologic ward were bacteriologically identified. The medical records of patients with S. mucilaginosus-positive blood cultures were retrospectively reviewed and evaluated. The antibiotic susceptibility pattern and restriction fragment length polymorphism (RFLP) of S. mucilaginosus were tested. RESULTS: S. mucilaginosus blood isolates from patients with hematologic malignancies were found to be as common as isolates of Staphylococcus aureus. Eleven patients with myelogenous leukemia and isolation of S. mucilaginosus from the blood are reported on. One patient had concomitant meningitis. All patients were neutropenic and most had oral mucositis and had been given ciprofloxacin prophylaxis. S. mucilaginosus isolates from these patients were resistant to ciprofloxacin in contrast to isolates from patients who had received other prophylactic regimens and seven isolates found in healthy individuals not recently treated with antibiotics. The resistant S. mucilaginosus were found to be of diverse genetic origin as determined by RFLP. CONCLUSIONS: The appearance of resistant strains during ciprofloxacin prophylaxis may be a predisposing factor for S. mucilaginosus septicemia. There was no evidence of a nosocomial spread of S. mucilaginosus strains.

Bacteremia due to Stomatococcus mucilaginosus in neutropenic patients in the setting of a cancer institute

“…All our patients had a relatively slow remission of fever (3–12 days). This is in accordance with other reports, where response to appropriate antibiotics was also slow [2,3]. The mortality rate reported in adult patients diagnosed as having S. mucilaginosus infection is 13% [3], and all our patients survived.…”

Induction of Cyclooxygenase-2 Signaling by Stomatococcus mucilaginosus Highlights the Pathogenic Potential of an Oral Commensal

“…Reports of bacteremia, central venous catheter sepsis, pneumonia, and meningitis with S. mucilaginosus have been seen in neutropenic patients (6-8, 16, 17). S. mucilaginosus pneumonia has also been reported in patients with HIV infection and in a patient following liver transplant (7,11,16). Few cases of infections by S. mucilaginosus have been reported in immunocompetent host (10).…”

“…mucilaginosus is an encapsulated Gram-positive coccus found in oral cavity as part of the normal flora that has been occasionally reported to cause severe infections in immunocompromised patients (6)(7)(8)(9)(10)(11)(12). It has been implicated in the causation of endocarditis (13,14), sepsis, and catheter-related bacteremia (8,15).…”

Rothia mucilaginosa bacteremia: A 10‐year experience of a pediatric tertiary care cancer center

“…Moreover, four of five patients received Pneumocystis jirovecii prophylaxis with trimethoprim/sulfamethoxazole, which might also be a risk factor per se for developing a Rothia mucilaginosa infection . In addition, there seems to be an emerging resistance of Rothia mucilaginosa to trimethoprim, as it was also found in one of the isolated strains of our patients …”

“…This might be due to the reduced gastric acid, allowing expansion of the oral flora to the lower digestive tract, thereby providing another portal of entry . The Rothia mucilaginosa strains are usually resistant to ciprofloxacin, which is well described in the literature and most likely due to the previously common use of ciprofloxacin for antibacterial prophylaxis during aplasia in adults with hematological malignancies . This strategy might cause a shift of the intestinal and upper respiratory tract flora toward gram‐positive bacteria .…”