Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation

Abstract

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).

Streptococcal bacteraemia in patients submitted to hematopoietic stem cell transplantation: The role of tooth brushing and use of chlorhexidine

“…When the incidence of positive blood cultures was evaluated in patients with OM and those ones who did not present OM in GA and GB, it was also observed that there was no statistically significant differences in the Groups. This data was contrary to data presented by other studies quoting OM as a cause of the bacteremia (1,(13)(14)(15)(16). It is worth mentioning that out of 19 (26%) positive blood cultures in 73 patients, only 1 (1.36%) was positive for α-hemolytic viridans streptococci (Streptococcus intermedius) and that happened in a patient from GB, who did not presented OM.…”

In Vitro Activities of the New Ketolide HMR 3647 (Telithromycin) in Comparison with Those of Eight Other Antibiotics against Viridans Group Streptococci Isolated from Blood of Neutropenic Patients with Cancer

“…Importantly, viridans group streptococcal bacteremia may be complicated by hypotension, septic shock, and adult respiratory distress syndrome, which have a high mortality rate (5,7,18,29). Oral penicillin V or roxythromycin added to a fluoroquinolone have resulted in significant reductions of viridans group streptococcal bacteremia (20,22).…”

High-dose cyclophosphamide with autologous lymphocyte–depleted peripheral blood stem cell (PBSC) support for treatment of refractory chronic autoimmune thrombocytopenia

“…Gram-positive coccal bacteremia is a common adverse event associated with PBSC transplantation and was also encountered in our series. 27 From this limited experience, it was unclear whether prior splenectomy affected the risk of bacteremia in our patients. CMV reactivation, as encountered in patient 005, is not uncommon following autologous PBSC transplantation.…”