Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
Infection. 2013 Oct;41(5):917-24. doi: 10.1007/s15010-013-0470-7. Epub 2013 May 3.
This retrospective study was performed in order to investigate the clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia (VSB) in febrile neutropenic children in the context of the increase in incidence and antibiotic resistance of VSB.
We conducted this study among neutropenic children with underlying hematology/oncology diseases who were diagnosed with VSB at a single institution from April 2009 to June 2012. Clinical and laboratory characteristics of the children as well as antibiotic susceptibility of the causative viridans streptococci were evaluated.
Fifty-seven episodes of VSB were diagnosed in 50 children. Severe complications occurred in four children (7.0%), and a death of one child (1.8%) was attributable to VSB. Acute myeloid leukemia was the most common underlying disease (70.2% of all cases), and 71.9% of all cases received chemotherapy including high-dose cytarabine. VSB occurred at a median of 13 days (range 8-21 days) after the beginning of chemotherapy, and fever lasted for a median of 4 days (range 1-21 days). The C-reactive protein level significantly increased within a week after the occurrence of VSB (p < 0.001) and the maximum C-reactive protein level showed a positive correlation with fever duration (r = 0.362, p = 0.007). Second blood cultures were done before the use of glycopeptides in 33 children, and negative results were observed in 30 children (90.9%). Susceptibilities to cefotaxime, cefepime, and vancomycin were 58.9, 69.1, and 100%, respectively.
Severe complications of VSB in neutropenic febrile children were rare. We suggest glycopeptide use according to the results of blood culture and antibiotic susceptibility tests based on the susceptibility to cefepime and the microbiologic response to empirical antibiotic treatment not including glycopeptides in this study.
本回顾性研究旨在探讨发热性中性粒细胞减少症患儿中草绿色链球菌菌血症（VSB）的临床特征和抗生素敏感性，因为 VSB 的发病率和抗生素耐药性都有所增加。
我们在 2009 年 4 月至 2012 年 6 月期间，对一家机构中诊断为 VSB 的患有血液/肿瘤疾病的中性粒细胞减少症患儿进行了此项研究。评估了患儿的临床和实验室特征以及引起 VSB 的草绿色链球菌的抗生素敏感性。
50 名患儿中确诊 57 例 VSB。4 名患儿（7.0%）发生严重并发症，1 名患儿（1.8%）因 VSB 死亡。最常见的基础疾病是急性髓细胞白血病（所有病例的 70.2%），所有病例中有 71.9%接受了包括高剂量阿糖胞苷在内的化疗。VSB 发生在化疗开始后第 13 天（中位数，范围 8-21 天），发热持续中位数为 4 天（范围 1-21 天）。VSB 发生后 1 周内 C 反应蛋白水平显著升高（p < 0.001），最大 C 反应蛋白水平与发热持续时间呈正相关（r = 0.362，p = 0.007）。33 名患儿在使用糖肽前进行了二次血培养，其中 30 名患儿（90.9%）的结果为阴性。头孢噻肟、头孢吡肟和万古霉素的敏感性分别为 58.9%、69.1%和 100%。
中性粒细胞减少症发热患儿的 VSB 严重并发症少见。根据本研究中未包括糖肽的经验性抗生素治疗的微生物学反应和对头孢吡肟的敏感性，我们建议根据血培养和抗生素敏感性试验的结果使用糖肽。
