Radocha J, Paterová P, Zavřelová A, Víšek B, Gabalec F, Žemličková H, Žák P
4th Department of Internal Medicine - Haematology, University Hospital Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic.
Institute of Clinical Microbiology, University Hospital Hradec Králové, Charles University, Sokolská 581, 50005, Hradec Králové, Czech Republic.
Folia Microbiol (Praha). 2018 Mar;63(2):141-146. doi: 10.1007/s12223-017-0542-7. Epub 2017 Aug 3.
Viridans group streptococci bloodstream infections (VGS BSI) remain a significant cause of mortality and morbidity in patients with severe neutropenia. The goal of our study was to evaluate clinical course and microbiological susceptibility of VGS BSI at our center. Retrospective analysis of all microbiologically documented bloodstream infections caused by VGS during the 9-year time period (from January 2006 until December 2014) was carried out. Only patients with severe neutropenia (< 500/μL) were included in the study. Clinical outcome and microbiological susceptibility pattern of isolates were recorded. Fifty-one individual patients with episode of VGS BSI were identified. The most frequent agent was Streptococcus mitis (23/51 cases, 45.1%). 88.2% (45/51) of patients were on recommended ciprofloxacin prophylaxis. 20/51 (39.2%) of patients suffered from mucositis at the time of diagnosis (10 patients had oral mucositis, 2 patients had bowel mucositis, and 8 patients both). Twenty-six patients (51.0%) had clinically relevant lung damage caused by VGS BSI (i.e., acute lung injury or acute respiratory distress syndrome). Twenty-four (47.0%) patients presented with bilateral lung infiltrated upon chest imaging, and two (4.0%) patients had unilateral lung infiltrates. Three patients (5.9%) died due to VGS BSI until day 28 of observation. No difference in signs of shock syndrome was observed in the patients during transplantation procedures compared to patients without transplantation as well as in a group received previous high-dose chemotherapy with cytosinarabinoside or in patients with mucositis. Only 3/51 of isolates (5.9%) were resistant to penicillin. All isolates were susceptible to empirical treatment. While the penicillin resistance of VGS remains low in middle Europe, initial antibiotic therapy of febrile neutropenia are still effective in most cases. The mortality and complication rates of VGS BSI were comparable to other studies, and no specific risk factor of shock presence could be identified.
草绿色链球菌血流感染（VGS BSI）仍是严重中性粒细胞减少患者死亡和发病的重要原因。我们研究的目的是评估我院VGS BSI的临床病程和微生物药敏情况。对9年期间（2006年1月至2014年12月）所有微生物学确诊的VGS所致血流感染进行回顾性分析。研究仅纳入严重中性粒细胞减少（<500/μL）的患者。记录分离株的临床结局和微生物药敏模式。共识别出51例VGS BSI发作的个体患者。最常见的病原体是缓症链球菌（23/51例，45.1%）。88.2%（45/51）的患者接受了推荐的环丙沙星预防治疗。20/51（39.2%）的患者在诊断时患有黏膜炎（10例患者有口腔黏膜炎，2例患者有肠道黏膜炎，8例患者两者均有）。26例患者（51.0%）因VGS BSI出现临床相关的肺损伤（即急性肺损伤或急性呼吸窘迫综合征）。24例（47.0%）患者胸部影像学显示双侧肺部浸润，2例（4.0%）患者有单侧肺部浸润。至观察第28天，3例患者（5.9%）因VGS BSI死亡。与未进行移植的患者相比，移植过程中的患者、接受过阿糖胞苷高剂量化疗的患者以及患有黏膜炎的患者在休克综合征体征方面未观察到差异。仅3/51的分离株（5.9%）对青霉素耐药。所有分离株对经验性治疗均敏感。虽然在中欧VGS的青霉素耐药率仍然较低，但发热性中性粒细胞减少的初始抗生素治疗在大多数情况下仍然有效。VGS BSI的死亡率和并发症发生率与其他研究相当，且未发现休克存在的特定危险因素。
