Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Infect Dis. 2013 Jun 17;13:273. doi: 10.1186/1471-2334-13-273.
This study was performed to compare the clinical characteristics and antibiotic susceptibilities of viridans streptococcal bacteremia (VSB) between febrile neutropenic adults and children with hematologic malignancies.
The consecutive medical records of neutropenic patients with hematologic malignancies who were admitted to the Catholic Blood and Marrow Transplantation Center between April 2009 and July 2012, and who were subsequently diagnosed with VSB were reviewed retrospectively. A comparison was made between the clinical and laboratory characteristics of adults and pediatric patients and also between patients with cefepime susceptible or not susceptible VSB.
A total of 202 episodes (141 in adults, 61 in children) of VSB were identified. Among them, 26 (12.9%) cases had severe complications including four (2.0%) cases of death attributable to VSB. For antibacterial prophylaxis, most adults received ciprofloxacin (97.1%), but children more frequently received trimethoprim/sulfamethoxazole (86.9%). Oral mucositis (p = 0.005) and abdominal pain (p = 0.001) were found more frequently in adults, and cough was found more frequently in children (p = 0.004). The occurrence rates of severe complications and death attributable to VSB were not significantly different between adults and children. Susceptibility rate to cefepime was significantly higher in adults than children (85.7% vs. 66.1%, p = 0.002). However, in multivariate analysis, cefepime susceptibility had no impact on clinical outcome.
There was no significant difference in clinical outcome between adults and children with VSB despite a difference in cefepime susceptibility. Hence, different antibiotic treatment strategies may not be necessary.
本研究旨在比较血液恶性肿瘤发热性中性粒细胞减少症成人和儿童患者中草绿色链球菌菌血症（VSB）的临床特征和抗生素敏感性。
回顾性分析 2009 年 4 月至 2012 年 7 月期间天主教血液和骨髓移植中心收治的血液恶性肿瘤中性粒细胞减少症患者的连续病历，这些患者随后被诊断为 VSB。比较成人和儿科患者的临床和实验室特征，以及头孢吡肟敏感和不敏感 VSB 患者之间的差异。
共确定了 202 例 VSB 发作（成人 141 例，儿童 61 例）。其中 26 例（12.9%）有严重并发症，包括 4 例（2.0%）归因于 VSB 的死亡。抗菌预防方面，大多数成人接受环丙沙星（97.1%），而儿童更常接受复方磺胺甲噁唑（86.9%）。成人更常出现口腔黏膜炎（p=0.005）和腹痛（p=0.001），儿童更常出现咳嗽（p=0.004）。成人和儿童 VSB 严重并发症和归因于 VSB 的死亡率无显著差异。成人对头孢吡肟的敏感性明显高于儿童（85.7% vs. 66.1%，p=0.002）。然而，多变量分析显示，头孢吡肟敏感性对临床结果没有影响。
尽管头孢吡肟敏感性存在差异，但 VSB 成人和儿童患者的临床结果无显著差异。因此，可能不需要采用不同的抗生素治疗策略。
