title: Bacteremia due to viridans streptococci that are highly resistant to penicillin: increase among neutropenic patients with cancer.
abstract: We prospectively studied 260 episodes of bacteremia that occurred over a 6-year period in neutropenic patients with cancer. Twenty-three episodes were caused by viridans streptococci. Thirteen (57%) of these strains were penicillin-resistant (MICs of penicillin ranged from 0.25 micrograms/mL to 8 micrograms/mL). Ten of the 13 penicillin-resistant strains (77%) were highly resistant to penicillin (MIC, > or = 4 micrograms/mL). Rates of bacteremia due to highly penicillin-resistant viridans streptococci increased significantly from zero episodes per 1,000 admissions in 1987 to 17 episodes per 1,000 admissions in 1992 (P = .003). In a comparison between penicillin-resistant and penicillin-susceptible viridans streptococci bacteremia, the administration of beta-lactam antibiotics during the previous 2 weeks was the only factor significantly associated with penicillin-resistant cases: 9 (69%) of 13 patients with penicillin-resistant bacteremia had received beta-lactams vs. 2 (20%) of 10 patients with penicillin-susceptible bacteremia (P = .036). These findings may have significant clinical implications in the choice of both antimicrobial prophylaxis and empirical antibiotic regimens.
authors.affiliation: Services of Infectious Disease, Ciutat Sanitària i Universitària de Bellvitge, University of Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Carratalá
authors.forename: F
authors.initials: F
authors.lastname: Alcaide
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Sevilla
authors.forename: X
authors.initials: X
authors.lastname: Corbella
authors.forename: J
authors.initials: J
authors.lastname: Lińares
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D010403:Penicillin Resistance; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology*