[Therapeutic impact of streptococcal and enterococcal bacteremia in hematology patients]

Pathol Biol (Paris). 2002 Apr;50(3):169-77. doi: 10.1016/s0369-8114(02)00284-5.
[Article in French]

Abstract

From January 1999 to May 2000 (17 months), 21 strains of streptococci and four strains of enterococci have been isolated from 74 blood cultures in 25 infectious episodes in hematologic patients. They concerned 21 patients, of 21 to 77 years old. These patients suffered from acute leukaemia (14 cases), chronic lymphoid leukaemia (two cases), non-Hodgkin's lymphoma (two cases) or myeloma (three cases). Seventeen patients displayed a single streptococcal or enterococcal episode, two had two episodes in the course of a single stay in the hospital, two others in the course of two different stays. During 16 episodes (64%), the bacteremia occurred within 15 days after the onset of neutropenia consecutive to antimitotic chemotherapy, and in nine episodes (36%) it has occurred after a period exceeding 15 days. In six cases the patients had already received antibiotics with a large antibacterial activity (beta-lactam, fluoroquinolone and/or glycopeptide +/- aminoside) and in four cases a single antibiotic (synergistine or cotrimoxazole). Most streptococci (20/21) were oral streptococci (ten Streptococcus mitis, five S. oralis, two S. sanguis, three S. pneumoniae). A single strain of beta-hemolytic streptococci has been identified as S. dysgalactiae subsp. equisimilis. The enterococci were one strain of Enterococcus faecalis and three E. faecium. Ten streptococci were susceptible to 0.25 mg/L of penicillin G, ten were less susceptible (0.5 < or = MIC < 32 mg/L), and a strain was resistant (MIC = 32 mg/L). Eighteen strains were susceptible to amoxicillin and cefotaxime. For three strains, the MICs of amoxicillin and cefotaxime (8-16 mg/L and 8-32 mg/L, respectively) were higher. Levels of resistance of the enterococci to the beta-lactam (penicillin, amoxicillin, and piperacillin) were variable. All species were susceptible to glycopeptides. Three patients were transferred in intensive care unit for respiratory distress or shock syndrome. Their evolution has remained severe under antibiotherapy comprising beta-lactam or vancomycin associated with an aminoside. This results demonstrate the interest of species identification to adapt the antibiotic treatment and confirms the frequency of oral streptococci in severe bacteremia in neutropenic patients.

MeSH terms

  • Adult
  • Aged
  • Aminoglycosides
  • Anti-Bacterial Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bacteremia / complications*
  • Bacteremia / microbiology
  • Critical Care
  • Cross Infection / complications
  • Cross Infection / drug therapy
  • Cross Infection / microbiology
  • Drug Resistance
  • Drug Therapy, Combination / therapeutic use
  • Enterococcus faecalis / drug effects
  • Enterococcus faecalis / isolation & purification*
  • Enterococcus faecium / drug effects
  • Enterococcus faecium / isolation & purification*
  • Female
  • Gram-Positive Bacterial Infections / complications*
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology
  • Hematologic Neoplasms / complications*
  • Hematologic Neoplasms / drug therapy
  • Humans
  • Immunocompromised Host
  • Lactams
  • Male
  • Middle Aged
  • Mouth / microbiology
  • Neutropenia / chemically induced
  • Neutropenia / complications
  • Opportunistic Infections / complications
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / microbiology
  • Pneumococcal Infections / complications
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / microbiology
  • Respiratory Distress Syndrome / etiology
  • Shock, Septic / etiology
  • Species Specificity
  • Streptococcal Infections / complications*
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology
  • Streptococcus / classification
  • Streptococcus / drug effects
  • Streptococcus / isolation & purification*
  • Streptococcus pneumoniae / drug effects
  • Streptococcus pneumoniae / isolation & purification
  • Streptococcus sanguis / drug effects
  • Streptococcus sanguis / isolation & purification
  • Treatment Outcome
  • Vancomycin / therapeutic use

Substances

  • Aminoglycosides
  • Anti-Bacterial Agents
  • Lactams
  • Vancomycin