Bacteremia Due to Viridans Streptococci That Are Highly Resistant to Penicillin: Increase Among Neutropenic Patients with Cancer

• Published in: Clinical infectious diseases Vol. 20; no. 5; pp. 1169 - 1173
• Main Authors: Carratalá, Jordi, Alcaide, Fernando, Fernández-Sevilla, Alberto, Corbella, Xavier, Liñares, Josefina, Gudiol, Francesc
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-05-1995; University of Chicago Press
• Subjects: Adult; Aged; Antibiotics; Antimicrobials; Bacteremia; Bacteremia - drug therapy; Bacteremia - etiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Blood; Cancer; Chemotherapy; Clinical Articles; Female; Human bacterial diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Neoplasms - complications; Neutropenia - complications; Penicillin; Penicillin Resistance; Predisposing factors; Prospective Studies; Streptococcal Infections - drug therapy; Streptococcal Infections - etiology; Streptococcus; Viridans Streptococci; Human; Leukopenia; Hemopathy; Malignant tumor; Bacteremia; Incidence; Infection; Penicillin derivatives; Resistance; Streptococcal infection; Risk factor; Bacteriosis; Neutropenia
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/20.5.1169

We prospectively studied 260 episodes of bacteremia that occurred over a 6-year period in neutropenic patients with cancer. Twenty-three episodes were caused by viridans streptococci. Thirteen (57%) of these strains were penicillin-resistant (MICs of penicillin ranged from 0.25 µg/mL to 8 µg/mL). Ten of the 13 penicillin-resistant strains (77%) were highly resistant to penicillin (MIC, ⩾4 µg/mL). Rates of bacteremia due to highly penicillin-resistant viridans streptococci increased significantly from zero episodes per 1,000 admissions in 1987 to 17 episodes per 1,000 admissions in 1992 (P = .003). In a comparison between penicillin-resistant and penicillin-susceptible viridans streptococci bacteremia, the administration of β-lactam antibiotics during the previous 2 weeks was the only factor significantly associated with penicillin-resistant cases: 9 (69%) of 13 patients with penicillin-resistant bacteremia had received β-lactams vs. 2 (20%) of 10 patients with penicillin-susceptible bacteremia (P = .036). These findings may have significant clinical implications in the choice of both antimicrobial prophylaxis and empirical antibiotic regimens.