Nielsen Maryke J, Claxton Sarah, Pizer Barry, Lane Steven, Cooke Richard P D, Paulus Stéphane, Carrol Enitan D
From the Department of Oncology, Alder Hey Children's NHS Foundation Trust (MJN, BP); Institute of Infection and Global Health, University of Liverpool (SC, EDC, SP); Institute of Translational Medicine, University of Liverpool (SL, BP); Department of Microbiology, Alder Hey Children's NHS Foundation Trust (RPDC); and Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust (SP, EDC), Liverpool, UK.
Medicine (Baltimore). 2016 Mar;95(9):e2952. 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.
草绿色链球菌（VGS）与发热性中性粒细胞减少症的高死亡率相关；然而，最近没有欧洲的儿科研究为抗菌治疗提供依据。本研究的目的是描述接受恶性肿瘤治疗或造血干细胞移植的VGS菌血症（VGSB）患儿的特征、结局和耐药模式。2003年至2013年期间，入住一家三级儿科血液肿瘤中心且患有VGSB的0至18岁患者被纳入研究。所有数据均从病历中回顾性收集。46例患者共发生54次菌血症发作。最常见的潜在诊断是复发性急性淋巴细胞白血病。缓症链球菌是最常见的病原体。共有30%的分离株对青霉素耐药，对万古霉素100%敏感。有8例（14.8%）草绿色链球菌休克综合征；6例需要入住重症监护病房，其中3例患者死于多器官功能衰竭。VGSB的潜在致命性得到证实。复发性急性淋巴细胞白血病的高风险值得注意。需要开展研究以制定风险分层评分，识别有草绿色链球菌休克综合征风险的儿童，从而指导发热性中性粒细胞减少症的经验性抗菌治疗。
