Cytosine arabinoside as a major risk factor for Streptococcus viridans septicemia following bone marrow transplantation: a 5-year prospective study.
The incidence and clinical course of nosocomial septicemia with Streptococcus viridans was evaluated prospectively in 242 consecutive bone marrow transplant (BMT) recipients throughout their 15-213 days' (median 47) hospitalization, including 4-58 days (median 18) of neutropenia. Initial empiric therapy for febrile neutropenia consisted of mezlocillin, gentamicin and cefazolin; glycopeptide was excluded. S. viridans septicemia occurred in 23/209 (11%) subjects with underlying malignant disease, and only during neutropenia with concomitant mucositis: in 20 subjects (four with ampicillin-resistant strains), S. viridans septicemia occurred at onset of febrile neutropenia, 1-5 days (median 4.5) post-BMT. All survived with an uncomplicated clinical course. Thus, glycopeptide seems unnecessary in the initial empiric antibiotic regimen. The other three subjects demonstrated S. viridans septicemia (two with ampicillin-resistant strains) on day 11 post-BMT; two died. The major risk identified was cytosine arabinoside administration in the conditioning regimen (P < 0.01).
Engelhard
D
D
Department of Pediatrics, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel.
Elishoov
H
H
Or
R
R
Naparstek
E
E
Nagler
A
A
Strauss
N
N
Cividalli
G
G
Aker
M
M
Ramu
N
N
Simhon
A
A
D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology*; D003561:Cytarabine / Q000009:adverse effects*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000209:etiology*
D003561:Cytarabine