Little Jessica S, Coughlin Cassie, Hsieh Candace, Lanza Meaghan, Huang Wan Yi, Kumar Aishwarya, Dandawate Tanvi, Tucker Robert, Gable Paige, Vazquez Deida Axel A, Moulton-Meissner Heather, Stevens Valerie, McAllister Gillian, Ewing Thomas, Diaz Maria, Glowicz Janet, Winkler Marisa L, Pecora Nicole, Kubiak David W, Pearson Jeffrey C, Luskin Marlise R, Sherman Amy C, Woolley Ann E, Brandeburg Christina, Bolstorff Barbara, McHale Eileen, Fortes Esther, Doucette Matthew, Smole Sandra, Bunnell Craig, Gross Anne, Platt Dana, Desai Sonali, Fiumara Karen, Issa Nicolas C, Baden Lindsey R, Rhee Chanu, Klompas Michael, Baker Meghan A
Harvard Medical School, Boston, Massachusetts, USA.
Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2024 Jan 25;11(3):ofae048. doi: 10.1093/ofid/ofae048. eCollection 2024 Mar.
is a ubiquitous gram-positive rod-shaped bacterium that can cause sepsis and neuroinvasive disease in patients with acute leukemia or neutropenia.
A single-center retrospective review was conducted to evaluate patients with acute leukemia, positive blood or cerebrospinal fluid test results for , and abnormal neuroradiographic findings between January 2018 and October 2022. Infection control practices were observed, environmental samples obtained, a dietary case-control study completed, and whole genome sequencing performed on environmental and clinical isolates.
Five patients with neuroinvasive disease were identified. All patients had acute myeloid leukemia (AML), were receiving induction chemotherapy, and were neutropenic. Neurologic involvement included subarachnoid or intraparenchymal hemorrhage or brain abscess. All patients were treated with ciprofloxacin and survived with limited or no neurologic sequelae. was identified in 7 of 61 environmental samples and 1 of 19 dietary protein samples-these were unrelated to clinical isolates via sequencing. No point source was identified. Ciprofloxacin was added to the empiric antimicrobial regimen for patients with AML and prolonged or recurrent neutropenic fevers; no new cases were identified in the ensuing year.
is ubiquitous in the hospital environment, at times leading to clusters with unrelated isolates. Fastidious infection control practices addressing a range of possible exposures are warranted, but their efficacy is unknown and they may not be sufficient to prevent all infections. Thus, including coverage in empiric regimens for patients with AML and persistent neutropenic fever may limit the morbidity of this pathogen.
是一种普遍存在的革兰氏阳性杆菌，可在急性白血病或中性粒细胞减少症患者中引起败血症和神经侵袭性疾病。
进行了一项单中心回顾性研究，以评估2018年1月至2022年10月期间急性白血病患者、血液或脑脊液检测结果为阳性且神经影像学检查结果异常的患者。观察了感染控制措施，采集了环境样本，完成了饮食病例对照研究，并对环境和临床分离株进行了全基因组测序。
确定了5例神经侵袭性疾病患者。所有患者均患有急性髓系白血病（AML），正在接受诱导化疗，且中性粒细胞减少。神经系统受累包括蛛网膜下腔或脑实质内出血或脑脓肿。所有患者均接受环丙沙星治疗，存活且神经系统后遗症有限或无后遗症。在61份环境样本中的7份和19份饮食蛋白质样本中的1份中检测到——通过测序这些与临床分离株无关。未发现点源。环丙沙星被添加到AML患者和长期或复发性中性粒细胞减少性发热患者的经验性抗菌治疗方案中；在随后的一年中未发现新病例。
在医院环境中普遍存在，有时会导致与无关分离株的聚集。需要采取严格的感染控制措施来应对一系列可能的暴露，但它们的效果尚不清楚，可能不足以预防所有感染。因此，在AML患者和持续性中性粒细胞减少性发热患者的经验性治疗方案中纳入覆盖范围可能会限制这种病原体的发病率。
