title: Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis.
abstract: OBJECTIVE
  Streptococcal infection has increasingly become a problem in neutropenic patients. We report on an outbreak of Streptococcus mitis sepsis in six bone marrow transplant patients receiving oral antimicrobial prophylaxis.
  
  
  METHODS
  We performed an epidemiologic study of all patients in our bone marrow transplant program from 1986 to 1988. The hospital and microbiology records for all patients were reviewed. All bone marrow patients were treated according to specified protocols, including an oral prophylactic antimicrobial regimen that was changed in late 1987 from vancomycin/polymyxin/tobramycin to norfloxacin. Identification, susceptibility testing, and whole cell protein analysis of streptococcal isolates were performed at the Reference and Antimicrobial Investigations Laboratories at the Centers for Disease Control.
  
  
  RESULTS
  We detected six cases of S. mitis sepsis among 21 patients undergoing bone marrow transplantation. No other concurrent pathogen was isolated from any patient at the time of the S. mitis bacteremia. Bacteremia developed within 72 hours of transplant in five of six patients and was associated with severe mucositis in four patients. An environmental study failed to reveal any common source for the outbreak, and whole cell protein analysis of all six S. mitis isolates revealed each to be distinct. Of 12 patients receiving oral vancomycin/polymyxin/tobramycin, one developed S. mitis bacteremia, versus five of nine patients receiving norfloxacin (p less than 0.03).
  
  
  CONCLUSIONS
  We believe S. mitis bacteremia is a potential complication of bone marrow transplantation and is associated with antimicrobial prophylaxis with norfloxacin, especially in the setting of mucositis.
authors.affiliation: Division of Infectious Disease, LDS Hospital, Salt Lake City, Utah 84143.
authors.forename: D C
authors.initials: DC
authors.lastname: Classen
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
authors.forename: C D
authors.initials: CD
authors.lastname: Ford
authors.forename: S
authors.initials: S
authors.lastname: Evershed
authors.forename: M R
authors.initials: MR
authors.lastname: Aloia
authors.forename: J K
authors.initials: JK
authors.lastname: Wilfahrt
authors.forename: J A
authors.initials: JA
authors.lastname: Elliott
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D009643:Norfloxacin / Q000627:therapeutic use; D011113:Polymyxins / Q000627:therapeutic use; D011292:Premedication; D018805:Sepsis / Q000453:epidemiology*; D013290:Streptococcal Infections / Q000453:epidemiology*; D013291:Streptococcus / Q000145:classification / Q000302:isolation & purification; D014031:Tobramycin / Q000627:therapeutic use; D014589:Utah / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D011113:Polymyxins; D014640:Vancomycin; D009643:Norfloxacin; D014031:Tobramycin