Infections Caused by Viridans Streptococci in Patients with Neutropenia

Clinical Infectious Diseases  1 Jun 2002  V.34  N.11  p.1524-1529

EMERGING INFECTIONS
INVITED ARTICLE

Allan R. Tunkel1 and Kent A. Sepkowitz2

1Division of Infectious Diseases, Department of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania; and 2Clinical Infectious Disease Section, Memorial Sloan-Kettering Cancer Center, New York, New York

The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10–15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock–like syndrome has been described; Streptococcus mitis has been the causative species in most cases. Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome. Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of antimicrobial prophylaxis for neutropenic patients with cancer should be reconsidered.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/340402

 

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/340402