Viridans Group Streptococcal Infections in Children After Chemotherapy or Stem Cell Transplantation: A 10-year Review From a Tertiary Pediatric Hospital

• Published in: Medicine (Baltimore) Vol. 95; no. 9; p. e2952
• Main Authors: Nielsen, Maryke J., Claxton, Sarah, Pizer, Barry, Lane, Steven, Cooke, Richard P.D., Paulus, Stéphane, Carrol, Enitan D.
• Format: Journal Article
• Language: English
• Published: United States The Authors. Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved 01-03-2016; Wolters Kluwer Health
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Antineoplastic Agents - therapeutic use; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Neoplasms - complications; Neoplasms - drug therapy; Observational Study; Outcome Assessment, Health Care; Retrospective Studies; Stem Cell Transplantation; Streptococcal Infections - diagnosis; Streptococcal Infections - drug therapy; Streptococcal Infections - microbiology; Streptococcal Infections - mortality; Tertiary Care Centers; Viridans Streptococci
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000002952

Viridans Group Streptococci (VGS) are associated with high mortality rates in febrile neutropenia; yet there are no recent European pediatric studies to inform antimicrobial therapy. The aim of this study was to describe the characteristics, outcome, and resistance patterns of children with VGS bacteremia (VGSB) undergoing treatment of malignancy or hematopoietic stem cell transplant. Patients aged 0 to 18 years, admitted to a tertiary pediatric hemato-oncology center with VGSB, from 2003 to 2013, were included in the study. All data were collected retrospectively from medical records. A total of 54 bacteremic episodes occurred in 46 patients. The most common underlying diagnosis was relapsed acute lymphoblastic leukemia. Streptococcus mitis was the most frequent organism. A total of 30% of isolates were resistant to penicillin and 100% sensitive to vancomycin. There were 8 episodes (14.8%) of Viridans Group Streptococcal Shock Syndrome; 6 resulted in admission to intensive care and 3 of these patients died of multiorgan failure. The potentially fatal nature of VGSB is confirmed. The high risk in relapsed acute lymphoblastic leukemia is of note. Research is needed to develop risk-stratification scores that identify children at risk of Viridans Group Streptococcal Shock Syndrome to guide empirical antimicrobial therapy in febrile neutropenia.