Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
J Antimicrob Chemother. 2024 Aug 1;79(8):2040-2047. doi: 10.1093/jac/dkae209.
Viridans group streptococci (VGS) bloodstream infection (BSI) frequently occurs in cancer patients receiving chemotherapy, and is associated with infective endocarditis (IE) in up to 20% of cases in the general population.
In cancer patients receiving chemotherapy with VGS BSI, we aimed to: (i) determine the incidence of infective complications including IE, (ii) assess the utility of echocardiography in this patient population, (iii) determine the duration and type of antimicrobial therapy received for monomicrobial infections, and (iv) determine the evolution of antimicrobial resistance.
VGS BSIs (excluding Streptococcus pneumoniae and Streptococcus pseudopneumoniae) in cancer patients receiving chemotherapy were identified from a statewide public pathology database between 2013 and 2022 at our tertiary centre. Medical records were accessed for clinical, microbiological and radiological data.
Of 581 patient episodes screened, 183 episodes involving 171 patients met inclusion criteria. Of these, 51% were bone marrow transplantation (BMT) patients, 40% were non-BMT haematology patients, and 8% were solid organ malignancy patients. The median age was 55 years, and 96% were neutropenic at the time of blood culture collection. A transthoracic echocardiogram was performed for 71% of episodes, and one patient met modified Duke's criteria for definite IE, although this diagnosis was not suspected on clinical grounds. Other complications were uncommon. Benzylpenicillin resistance was rare (2.9%) and did not change over time. Most episodes (75%) were treated with piperacillin/tazobactam. For monomicrobial BSIs, the median antibiotic duration was 5 days (IQR 2-7) post-neutropenia resolution.
Infective complications and antimicrobial resistance are rare in cancer patients with VGS BSI. This may provide a safe opportunity to limit both investigations (e.g. echocardiogram) and prolonged exposure to broad-spectrum antimicrobials.
草绿色链球菌（VGS）血流感染（BSI）在接受化疗的癌症患者中经常发生，并且在普通人群中，多达 20%的病例与感染性心内膜炎（IE）有关。
在接受化疗的 VGS BSI 癌症患者中，我们旨在：（i）确定包括 IE 在内的感染性并发症的发生率，（ii）评估超声心动图在该患者人群中的应用价值，（iii）确定单微生物感染接受的抗菌治疗的持续时间和类型，以及（iv）确定抗菌药物耐药性的演变。
在我们的三级中心，从 2013 年至 2022 年，从全州公共病理学数据库中确定了接受化疗的癌症患者中的 VGS BSI（不包括肺炎链球菌和假肺炎链球菌）。查阅病历以获取临床、微生物学和放射学数据。
在筛查的 581 例患者中，183 例涉及 171 例患者符合纳入标准。其中，51%为骨髓移植（BMT）患者，40%为非 BMT 血液学患者，8%为实体器官恶性肿瘤患者。中位年龄为 55 岁，在血培养采集时 96%为中性粒细胞减少症。71%的病例进行了经胸超声心动图检查，虽然在临床上没有怀疑，但有 1 例患者符合改良的 Duke 标准的明确 IE。其他并发症并不常见。青霉素耐药性罕见（2.9%），且随时间变化不大。大多数病例（75%）采用哌拉西林/他唑巴坦治疗。对于单微生物 BSI，中性粒细胞减少症消退后抗生素的中位治疗时间为 5 天（IQR 2-7）。
癌症患者 VGS BSI 感染性并发症和抗菌药物耐药性罕见。这可能为限制调查（例如超声心动图）和减少广谱抗菌药物暴露提供了安全的机会。
